
Glass. 
Book_ 



GopiglitN". 



31 



-d^ 



COPYRIGHT DEPOSIT. 



THE NURSING 
OF CHILDREN 



By 

MINNIE GOODNOW, R.N. 

and 

ZULA PASLEY, R.N. 



New York 

Lakeside Publishing Company 

1914 



.<k' 



l> 



Copyright, 1914 

By 

Lakeside Publishing Company 

New York 



DEC 31 1914 

©CI.A391197 



CONTENTS 

Introduction 3 

Part I. Preparation for the Baby . 5 

Part II. Early Care 19 

Part III. General Care of a Young 

Baby 36 

Part IV. Feeding 47 

Part V. Feeding of Small Children . 68 

Part VI. Premature Babies ... 81 

Part VII. Nursing in Abnormal or 

Diseased Conditions . . . .100 

Part VIII. Diseased Conditions . .113 

Part IX. Communicable Diseases . 135 

Part X. Other Diseased Conditions . 156 

Part XI. Nervous Conditions and 
Diseases of the Nervous System . 171 

Part XII. Clothing 185 

Part XIII. Teaching 192 

Part XIV. Entertaining Children . 198 



INTRODUCTION 

THIS little volume, dealing mth the 
nursing of infants and sick children, 
compiled from a series of articles which 
originally appeared in The Trained Nurse 
AND Hospital Review, should have a 
hearty welcome in training schools and by 
nurses whose experience in the care of sick 
children has had to be gained after grad- 
uation. 

Of books dealing with diseases of children 
there has been no lack, but our Uterature on 
the subject of the actual care of the child 
who has the disease has been scanty, indeed. 

In the preparation of these chapters Miss 
Goodnow's experience as nurse, superin- 
tendent, teacher and careful student of 
methods, has been supplemented by Miss 
Pasley 's first-hand knowledge of present-day 
methods in the actual care and management 
of sick children. 

In a book of this size, all matter has nec- 
essarily had to be condensed — a condition 
which should prove an advantage rather 
than otherwise to the busy nurse. The 
book has been wTitten by nurses, for nurses. 



and for those in the home who are forced by 
necessity to assume charge of the bedside 
care of a sick child or an infant. It does not 
assume to be a treatise on the diseases of 
children. 

We prophesy for the little volume a wide 
circulation, and trust that it may prove of 
practical help and value, at some time, to 
all who may turn to its pages for suggestion. 

Charlotte A. Aikens. 



PART I 

Preparation for the Baby 

THE nurse who desires to be efficient in 
her work for children begins her use- 
fulness by helping the prospective mother. 
She should advise when pregnancy is sus- 
pected that the patient visit her physician 
early, have the fact of pregnancy estab- 
lished or disproven, and keep in touch with 
him, so that he may direct her physical care 
during the period. 

If the nurse is asked for advice by a preg- 
nant woman she should counsel simple, 
sensible living, leaving the details to the 
doctor. She will be called upon, however, 
to deal with many minor points, as a woman 
always feels that another woman under- 
stands better than a man possibly can and 
is more sympathetic in this wonderful mat- 
ter of the entrance of a new Hfe into the 
world. She will have to answer questions 
in regard to the traditions which are still 
current, and should herself know the truth 
concerning them. The various modes of 
telling whether the child is to be a boy or a 



The Nursing of Children 

girl are interesting, but all fail more or less 
frequently, and are not to be taken seriously. 
The most difficult subject is that of prenatal 
influence and maternal impressions, with 
the consideration of birthmarks and de- 
formities. The authorities differ in regard 
to these matters, and among the medical 
fraternity one will find equally capable men 
holding opposite views; but most of the 
biologists feel that the whole subject and its 
so-called proofs are merely the result of co- 
incidence. It is a fact that the majority 
of pregnant women go through experiences 
which ought, if the traditions held good, to 
produce marks, deformities, strange tend- 
encies, etc., and yet these things do not 
occur except in occasional instances. If 
such matters were cause and eflFect, the 
effect would not be lacking in nine cases out 
of ten. It is, however, a matter of common 
sense and fair play that a prospective mother 
should be protected from unpleasant occur- 
rences, given cheerful surroundings, and 
helped in maintaining a calm mental state. 
In the matter of premature children one 
constantly hears that eight-months babies 
do not live, while seven-months do. Such 

6 



The Nursing of Children 

statements not only contradict common 
sense, but are disproved by facts. The idea 
doubtless arose from inexact observation 
and ignorance of the exact amount of pre- 
maturity. 

When tales of terrible suffering at the 
time of delivery, blood poisoning, abscessed 
breasts, etc. are brought to a nurse, she may 
say simply that modern scientific treatment 
has practically eradicated nearly all of the 
old-time complications. She may even use 
these things as arguments in favor of having 
skilled care. 

Clothing — The nurse is almost always 
called upon to advise in regard to clothing 
for the baby, and should know something 
of the quality and durability of materials. 
Shopping for the layette should begin about 
the third month of pregnancy, and any 
machine stitching should be finished before 
the sixth month. Embroidery and fine 
hand work may be reserved for the later 
months. After the sixth month there 
should always be a moderate supply of 
things ready in case of premature birth. 

Advise the bu3dng of good flannels, as 
these, if properly made and cared for, may 



The Nursing of Children 

be used for a long time. All-wool flannel 
does not launder well; silk-and-wool or 
linen-and-wool is better. A good quality of 
either may be obtained for about ninety 
cents a yard. If the petticoats are made 
quite full (one or one-and-a-quarter yards 
at the bottom) they can be used imtil the 
child is three or four years old. A cheaper 
flannel (forty cents a yard) may be used for 
pinning blankets, as these are used but a 
comparatively short time. For the bands, 
buy a half yard of forty-cent flannel, leaving 
it uncut, so that it may be torn into strips 
of the proper width at the time it is used. 
Bands should not be hemmed or embroid- 
ered, and if made beforehand are apt to be 
too large or too small. They may be made 
with darts, but these are easily stitched in. 
The band should never be pinned on, but 
sewed or basted. It should be loose enough 
to admit the nurse's finger as she sews, but 
snug enough to stay in place. 

The shirts which have a double front are 
undoubtedly best, as they afford more pro- 
tection where it is needed. They should be 
fastened by a few stitches or with the tiniest 
of safety pins. (Imagine yourself with a 

8 



The Nursing of Children 

four-inch blanket pin in the middle of your 
back and you will have some idea of the 
reason for omitting pins altogether.) Use 
the second size of shirts, as the smaller ones 
shrink or are outgrown very quickly. These 
may be silk-and-wool or linen-and-wool, and 
in warm weather cotton or linen mesh. 

The best material for dresses is nainsook, 
for which one pays 20 or 25 cents a yard. 
Lawn rumples badly and does not wear or 
laimder well; other materials are too heavy. 
If the sKps are made with draw-strings at 
the neck and wrists and armholes amply 
large, they will not require making over as 
the child grows. Nightgowns are best of 
flannelette, except for summer, when nain- 
sook or longcloth may be used. If they are 
made of wool flannel, the neck should have 
a silk or linen binding. The petticoats 
should be made princess or with a waist, so 
that they hang from the shoulders. An 
attempt to fasten clothing about a baby's 
waist or chest results in its dragging and 
being always imcomfortable and untidy. 
None of the clothing should be longer than 
24 inches from shoulder to bottom of hem. 
The regulation 27 inches makes simply 



The Nursing of Children 




FIGURE I 



more material to pull and drag and does not 
aid in keeping the baby warm. 
Cotton advises instead of the usual slip, 



lO 



The Nursing of Children 

a sleeveless garment to be made of Scotch 
flaimel. The neck is finished smoothly and 
the bottom has a draw-string by which it is 
drawn up like a bag, keeping the feet warm 
and making a garment which will stay in 
place. The arms are of course included in 
the bag thus keeping the hands away from 
the face and preventing scratching or infec- 
tion of eyes. He suggests that a similar 
slip be worn underneath in cold weather, 
this one being pro^dded with armholes. A 
silk-and-wool shirt, diaper and stockings 
complete the costume. This is advised for 
only the first six weeks It is particularly 
good for very small or premature babies. 

Soft wool stockings or long bootees should 
be provided except in summer. They must 
be pinned to the diaper with tiny safety 
pins or they will not stay in place. Short 
jackets are useful to keep the neck and 
shoulders from chilling when they get un- 
covered. These may be made of wool, 
flannelette, or silk. 

The diapers may be made of a thin outing- 
flannel. This is soft, absorbent and easy 
to launder. Canton flannel is clumsy and 
is not absorbent nor soft until pretty well 

II 



The Nursing of Children 




FIGURE II 

worn. Linen is almost too absorbent and 
soon becomes cold and clammy if wet. 
Birdseye-cotton is excellent, but is almost 
sure to become gray after a few weeks 
laimdering. The Arnold knit diapers are 
very satisfactory, but are expensive. 

The following list of clothing will be found 
to fit the requirements in most cases: 

Three shirts, second size; 4 pairs stock- 
ings; 4 flannel petticoats, 4 wool pinning 
blankets; material for 3 or 4 flannel bands; 
10 or 12 dresses or slips,; 3 jackets; 50 



12 



The Nursing of Children 

diapers, 22 or 24 inches square; 2 or 3 head 
shawls; 2 soft blankets or small comfort- 
ables, washable. 

The head shawls should be of very fine 
soft wool or sUk, as no harsh material should 
ever come against the baby's face. A coat 
and a bonnet may be provided later, when 
the child begins to go out, but are not neces- 
sary at the first. 

A special hot water bag should be pro- 
vided, and scales for the daily weighing. 
The baby basket should contain the follow- 
ing articles: 

Two soft towels (old table linen is nice for 
these); soft old linen or gauze for wash- 
cloths; castile soap, (the genuine); bath 
thermometer; large and small safety pins; 
boric acid in. powder; boric acid in solution; 
white vaseline, sterilized; package absorbent 
cotton, sterilized; package sterile gauze; pair 
of scissors; plain talcum powder; soft old 
blanket; full set of clothing for first dressing. 

Bed — Some sort of a bed or bassinet 
should be ready for the reception of the 
baby. The material and style of this may 
be left to the taste and purse of the mother. 
A clothes basket may be used, padded and 

13 



The Nursing or Children 

lined with pink, blue or white, with a deep 
ruffle of the same covering the outside. One 
may even use a baby carriage as a bed if it is 
flat in the bottom. The simplest and most 
practical thing is a small metal bed; with 
a hair mattress it will be both comfort- 
able and sanitary. If an ordinary crib be 
used it will do until the child is six or seven 
years old. There should be a quilted pad 
over the mattress and it should be further 
protected by rubber or waterproof sheeting, 
preferably double coated. Cambric sheets, 
light wool blankets and if desired, a light 
spread make the bed complete. No pillow 
is needed for some months, though a thin 
one may be used later on. 

The Nurse — ^It ought to be an axiom that 
no nurse should take an obstetric case, ex- 
cept in an emergency, and thus undertake 
the care of a young baby, unless she has had 
good training for this work. Good training 
means, in most instances, special training, 
for few general hospitals give more of this 
work than a mere smattering. The nurse 
is expected to be a teacher of principles and 
methods. She must be equipped with both 
popular and technical knowledge. She 

14 



The Nursing of Children 

must know what things are so and why they 
are so. 

Books — It is well to be able to recommend 
books from which the young mother may 
gain information. Holt's ^^ Care and Feed- 
ing of Children" is perhaps the most com- 
plete work for popular use and is considered 
an authority. Fischer's ''The Care of the 
Baby/' Wheeler's "The Baby— His Care 
and Training," Cotton's ''Home Econom- 
ics" series and Griffith's "Care of the 
Baby" are among the best. There are 
some excellent chapters on the subject in 
Aiken's "Home Nursing." These are all 
rehable works and are written for the aver- 
age intelligent mother. Schinn's "Biogra- 
phy of a Baby" is a scientific study of a 
child's development, and is told in an 
interesting manner. 

The importance to both mother and child 
of proper care for the baby during the first 
few days cannot be overestimated. It is 
these few days which set the pace for 
months to come, and it is duriag them often 
that a nurse makes or immakes her repu- 
tation. 

Discrimination — Few people, even doc- 

15 



The Nursing of Children 

tors and nurses, understand that children 
are born with dispositions, and that these 
dispositions must be dealt with in one way 
or another from the hour of birth. The 
nurse who takes advantage of her oppor- 
tunities will observe that one child is impa- 
tient and wilful and another serene and 
yielding from the first day of life. It is just 
as impossible to succeed if one treats all 
babies alike as it is if one treats all men and 
women alike. Adaptability nowhere finds 
a wider application than in the care of 
young babies. 

The Babys Characteristics — What is the 
baby at birth? Most physicians denomi- 
nate him '^simply a little animal." The 
sight is somewhat undeveloped, in that dis- 
tance is not distinguished at all and only 
nearby objects are clearly seen. The color 
sense is non-existent. Taste is not devel- 
oped, but the baby's mouth is very sensitive 
to heat and cold or to pungent foods. The 
sense of smell appears gradually, along with 
that of taste. The sense of touch is well 
developed chiefly in tongue, lips and eyes. 
It is undoubtedly true that ^'a baby's only 
conscious sensation is in its mouth." The 

i6 



The Nursing of Children 

sensory nerve endings in the skin are little 
developed, which results in this, that a baby 
may be badly injured without being itself 
conscious of it enough to protest. To this 
are due some of the accidents with hot water 
bottles, etc. The lungs inhale relatively 
more oxygen and expel more carbon dioxide 
than in adults. The sweat glands are not 
active at birth. Tears do not appear nor- 
mally until about the third month. 

The respiration at birth is about 45 per 
minute. Rotch says "The breathing is 
superficial, sometimes quick and again dying 
away so as to be almost imperceptible." 
Good authorities say that the temperature 
of a new-bom baby is from 99 to 100° but 
it falls two or three degrees within the first 
hour and fluctuates for several days, being 
at the end of the first week normally 99°. 
In actual practice, the average baby tends 
to record a subnormal temperature for some 
weeks, and it will rarely be as high as 99 
unless there is some functional disturbance. 
The average height of males at birth is 
19^ inches, of females 19^ inches. The 
average weight of males is 7^ pounds, and 
that of females 7^ pounds. The ten, 

17 



The Nursing of Children 

twelve and fifteen pound babies of which one 
hears are exaggerations or guesses, or due 
to the child being weighed with a consid- 
erable amount of clothing. Babies which 
weigh ten pounds at birth without clothing 
are very uncommon and a child larger than 
that is almost never seen. 



i8 



PART II 

Early Care 

/^ARE at Delivery — When a child is de- 
livered, the physician is usually there 
to direct the immediate care. 

Most doctors expect the nurse to wash 
out the child's eyes and mouth. This 
should be done carefully with warm boric 
solution. Most doctors prefer to tie the 
cord themselves; if a nurse is asked to do it, 
she must see that her hands are sterile. If 
the child is not breathing properly, the 
physician will be responsible for the treat- 
ment which may be needed, but every nurse 
should know how to do artificial respiration 
in order to be of proper assistance and to be 
prepared to act in case of trouble after the 
doctor's departure. The nurse should fa- 
miliarize herself with the different methods 
of encouraging breathing, and should under- 
stand thoroughly the principles involved. 
This is best learned by actual demonstra- 
tion, and should precede the regular obstet- 
rical training. 

The cord cut, eyes and mouth cleansed 

19 



The Nursing of Children 

and respiration established, the child is 
given over to the nurse, and thenceforth the 
average physician pays very little attention 
to it. 

No nurse who has had proper obstetrical 
training will desire to be left alone at the 
delivery. If circumstances delay the arrival 
of the physician and it seems likely that she 
will have to get on without him, she should 
sterilize a pair of scissors and two hemo- 
static forceps (if she has them), or two or 
three 12-inch lengths of bobbin tape. She 
should prepare her solutions and get every- 
thing within reach. In scrubbing her hands 
the usual precautions should be taken about 
thoroughness. Full-strength alcohol or per- 
oxide of hydrogen are rapid and sure disin- 
fectants after the scrubbing. 

The actual expulsion of the head should 
be retarded as much as may be, to prevent 
laceration. When the chin is delivered, the 
nurse may feel with one finger to ascertain 
whether or not the cord is around the baby's 
neck; if so, it is to be gently slipped off. 
The shoulders should be delivered carefully. 
When the cord has ceased pulsating, a clamp 
may be put upon it, about an inch from the 

20 



The Nursing of Children 

child's navel, the other a greater or less dis- 
tance from it, toward the placental side. 
The cord may then be tied, or the clamp left 
on till a convenient time comes. 

The baby, upon delivery, should be re- 
ceived into a warm, sterile towel held in the 
nurse's hands, and should be laid upon its 
right side (to insure closing of the foramen 
ovale), wrapped in a warm blanket, the 
towel being left to protect the face and eyes 
from the roughness of the blanket, and the 
cord from the possibility of infection. The 
baby may be laid in bed or basket or in a 
rocker or arm chair which is well padded. 
In cold weather, it is wise to cover it with a 
second blanket, and place a hot-water bag 
in the folds, being careful to avoid possibility 
of burning. 

If the child is in good condition, it may be 
left while the nurse assists in the care of the 
mother. An occasional look at it in passing 
is sufficient to assure oneself and the family 
of its well-being. If the physician wishes 
the Crede treatment applied to the eyes, he 
will attend to it before he leaves. This con- 
sists of one or two drops of a 2 per cent, 
solution of silver nitrate put into each eye. 

21 



The Nursing of Children 

The nurse should see that a clean dropper is 
ready for the silver solution and another for 
the sterile water or salt solution, which is 
usually used after the application. She 
must provide the salt solution and a sterile 
glass in which to pour it. 

Bear in mind that as soon as the mother 
is clean and comfortable she will want to 
see her child. Even though it may not be 
attractive in its first wrappings, her desire 
should be granted. After she has really 
seen the baby, she will be content to have 
it taken out of the room while she gets some 
rest. 

A new-born baby, if kept well wrapped 
and carefully watched, may with perfect 
propriety be left for some time without fur- 
ther attention. The mother, even if asleep, 
needs strict watching for some hours after 
delivery, and is less likely to get it if the 
nurse is absorbed with the baby. More- 
over, when one thinks of the radical changes 
which take place at birth, the establishment 
of breathing, the change in the blood cur- 
rent, the shock of contact with the outer air 
and the various hard and soft substances, 
the lights, movements, sounds, etc., the 

22 



The Nursing of Children 

nervous strain of handling to which the little 
being is entirely unaccustomed, one finds 
much to condemn in the customary haste in 
getting at the bathing and dressing. Give 
the baby a chance to adjust itself partially 
at least to the strangeness of the world, be- 
fore you add many new sensations. 

The Nursery — If it is at all possible, every 
family should arrange for a nursery, however 
small. It should be a sunny room, but the 
crib should be set so as to screen the light 
from the baby's eyes. There should be no 
carpet, but soft, washable rugs should be 
provided. The floor is best of hardwood, 
finished with oil or varnish rather than wax, 
as it must not be slippery; a highly polished 
floor is not safe for a nurse with a baby in 
her arms and certainly not for little feet 
when they are taking their first steps. 
There should be no upholstered furniture, no 
draperies except washable curtains, and no 
ornaments except pictures which are inter- 
esting to children. Provide for the baby's 
wardrobe a roomy box (such as a shirtwaist 
box) or a chiffonier. Let cleanliness, sim- 
plicity, order and quietness be especially 
sought for the nursery. Good ventilation 

23 



The Nursing of Children 

should be provided, and this means making 
a study of that particular room in order to 
avoid drafts and give an abundance of fresh 
air. The temperature of the room for the 
first few days should be nearly 78°, and for 
a few weeks when the baby is bathed it 
should be kept very warm, but may gradu- 
ally be cooled until by the time the baby is 
a month old it is not more than 70°. 

Bathing — As soon as possible after deliv- 
ery, the child should be well anointed with 
sterile olive oil or white vaseline, especially 
in the folds of the groins and about the neck 
and head. Within a half hour after this 
application, it will be found that the cheesy 
material (vernix caseosa) which was present 
has disappeared. Gentle sponging with not 
too strong soapsuds at a temperature of 
100° to 105° will remove the oil and any 
foreign matter which may be present. A 
tub bath is, as a rule, objectionable, because 
of the danger of infecting the cord; but one 
may appropriately be given if for any reason 
the child is blue or chilled. 

In giving the bath do not assume the awk- 
ward and inconvenient position of sitting in 
a low rocker with the tub on the floor and 



2A 



The Nursing of Children 

the child in your lap. Use a table. In 
private practice the kitchen or dining-room 
table is usually the best, and with a folded 
blanket over it makes a good arrangement. 
In hospitals an ordinary pine table may be 
padded and covered with oil cloth. In cold 
weather it is best to place a hot water bag, 
not too full nor too hot, between the folds 
of the blanket upon which the baby is laid. 

For a sponge bath have the water at a 
temperature of 105°, as it cools very rapidly. 
For a tub bath, make it 100°; by the time the 
baby is undressed and ready it will have 
cooled to about blood heat. The tempera- 
ture should be reduced after a week or two, 
and the child gradually accustomed to cool 
water. The softest of wash cloths and 
towels should be used and the utmost care 
exercised in drying. If properly absorbent 
materials are used there is no excuse for 
rubbing, as the drying can be done by gentle 
patting. Powder is unnecessary, but may be 
used sparingly if it does not irritate the skin. 
Always note carefully what effect powder 
has, as it may be responsible for things 
otherwise unaccoimtable. 

When a tub bath is to be given, the baby 

25 



The Nursing of Children 

should be wrapped in a diaper or soft towel 
and lowered slowly into the water. If the 
water is not exactly the right temperature 
(blood heat) or the child is thrust into it 
carelessly or suddenly, a permanent dislike 
or even fear of baths may result. Special 
attention should be given to the groins, the 
folds about the neck and under the arms. 
The head should be washed at each bath; 
when this is neglected an eczema sometimes 
results. If a brown, crusted condition ap- 
pears on the scalp, several thorough oilings 
and subsequent bathing will remove it. 

The eyes should be sponged off daily with 
warm boric acid solution. They should not 
be washed out unless the physician orders it. 
Any discharge should be at once reported. 

The daily bath is not now considered 
essential. Some doctors prefer not to bathe 
the child at all until it is ten days or two 
weeks old, except so much as is needed for 
cleanliness. For very small or weak chil- 
dren bathing is always contra-indicated, and 
oil rubs should be given instead. Use for 
this purpose albolene, cocoanut oil or ben- 
zoinated lard, as olive oil, even if pure, is not 
readily absorbed. Employ a gentle knead- 

26 



The NimsiNG of Children 

ing movement for the arms and legs and a 
circular stroke for chest, abdomen and back. 

Even if the bath be omitted, there should 
be an entire change of clothing twice a day. 
It is not always necessary to send the gar- 
ments to the wash, but they should be well 
aired before being used again. The change 
of clothing at bedtime is quite as important 
as in the morning. A baby is no more 
likely to be comfortable sleeping in its day 
garments than an older child is. Attention 
to this small point may save many a sleepless 
night for both mother and nurse. 

Treatment of the Cord — Unless you are 
familiar with his practice, always ask the 
physician how he wishes the cord dressed. 
As a matter of fact, one method appears to 
be as good as another, providing the mate- 
rials used are sterile. Dry cotton and pow- 
dered boric acid are commonly employed; 
talcum powder, salicylic acid, bismuth, zinc 
oxide ointment, etc., are used. If the cord 
is a little ^^ juicy" or there is any redness 
about it, pure alcohol will almost invariably 
check it. After the first dressing, a thor- 
ough letting alone is the best treatment. A 
daily inspection and change of dressing if it 

27 



The Nursing of Children 

becomes soiled are all that is usually neces- 
sary. 

It is customary in putting on the band to 
turn the cord to the left, in order to avoid 
its pressing upon the liver, but no harm is 
done if this tradition is not observed. 

The Excretions — ^The child's bowels should 
move thoroughly during the first twenty- 
four hours of life. If they do not of their 
own accord, an enema should be given. 
This may be done with a small soft rubber 
catheter, connected to a funnel, or with an 
infant's bulb syringe. The syringe is more 
easily managed, but great care must be 
exercised in inserting the tip. Plain warm 
water may be used, or a very weak soap suds 
if it seems to be needed. The ancient and 
honorable formula of molasses and water is 
not objectionable, but is unnecessary. 

The first urine voided is usually scanty 
and high-colored. It may contain a red 
sediment which can easily be mistaken for 
blood. The time, quantity and frequency 
of urination should be made a note of. A 
child may fail to urinate for the first twenty- 
four hours without anything being wrong. 
Sometimes the quantity is very small and is 

28 



The Nursing of Children 

almost colorless, so that it might be over- 
looked. If the child has not voided after 
twenty-four hours, a warm normal salt solu- 
tion enema may be used eflfectively. Water 
given freely by mouth and moist heat ap- 
plied over the abdomen and genitals help 
greatly in the matter. If a child goes over 
thirty-six hours without urinating, the phy- 
sician should be called upon to take the 
matter in hand. 

Water — Beginning the first day of life, 
water should be given regularly. Half an 
ounce, or even an ounce, every four hours, is 
not too much. Do not give it from a bottle 
till after the habit of nursing is established, 
or the baby may refuse to nurse. Use a 
spoon in the beginning, but be sure that the 
baby takes the water and that it is not dis- 
tributed over its face and clothing in place 
of being put into its stomach. Feeding a 
baby water from a spoon takes considerable 
time, but pays in the end. In ordinary 
cases it is better not to give water at all until 
after the baby has once nursed well. 

Nursing — The first nursing should take 
place as soon as the mother is rested and the 
child washed and dressed. If the mother 



29 



The Nursing of Children 

has any tendency to hemorrhage, the baby 
should be put to the breast much sooner, as 
the stimulation of the nipple tends to pro- 
duce uterine contractions and so stop bleed- 
ing. If mother and baby are in good condi- 
tion some physicians prefer to wait twelve 
hours. Three or four times during the first 
twenty-four hours and about five times the 
second and third day is sufficiently often. 
There is very little fluid in the mother's 
breasts during this period, but the first 
secretion (called colostrum) is laxative and 
needed by the baby. It is also important 
that the nursing habit be established. 

The mother or some solicitous relative 
may suggest feeding the baby before the 
milk appears. One should insist in such a 
case upon following Nature's suggestions, 
which very plainly say ''No" to this proce- 
dure. The baby is rarely hungry and can- 
not be induced to nurse often, since the little 
body contains stored-up sustenance enough 
to last for a few days; moreover, the very 
absence of milk in the mother's breasts is in 
itself a hint that it is not needed. 

Remember that a primipara rarely knows 
how to properly nurse her baby, and that it 

30 



The Nursing of Children 

is the nurse's duty to teach her. Have her 
lie well over on her side, so that breast will 
come squarely in front of the baby's mouth. 
The baby's head may be supported by her 
arm or a thin pillow, but it is quite as satis- 
factory to omit either and lay the baby flat 
upon the bed. The mother should be 
shown how to support the breast with her 
hand, holding the nipple so that the baby 
may be able to get and retain its hold. 
Much of the difficulty about getting a baby 
to nurse is due to its being placed in an awk- 
ward position so that the child starts out by 
being discouraged. These matters seem 
small, but they lie at the root of success. If 
the milk seems not to flow freely, gentle 
massage of the breast or warm applications 
may assist. If it flows too freely the mother 
may with her first and second fingers near 
the nipple retard it. 

The duration of each nursing varies ac- 
cording to the flow of milk and the vigor 
with which the baby nurses, being from ten 
to twenty minutes. The nurse must study 
the individual baby and adapt her procedure 
to it. If the child refuses to waken or seems 
not to be hungry, it may be allowed to sleep, 

31 



The Nursing of Children 

and the mother may be assured that when 
it is really hungry it will nurse properly. 
The baby's sleepiness should not be made an 
excuse for omitting an attempt at nursing 
when it is time, as irregular habits are 
quickly formed which are annoying to the 
mother and bad for the child. The nursing 
schedule should be as follows: Beginning 
early in the morning, whenever the child 
wakens, say at five or six o'clock, a persist- 
ent attempt should be made at nursing every 
two hours up to bedtime, say nine o'clock. 
Every four hours during the night is often 
enough, and a healthy baby which is doing 
well should not be wakened even as often as 
this. It may be allowed to sleep all night if 
it will. This routine will make nursings 
come at 5, 7, 9 and 11 a.m., and at i, 3, 5, 7 
and 9 P.M.. with a night nursing about one 
o'clock. In this way the mother is not dis- 
turbed and robbed of her rest and the baby 
is taught to sleep at night. It takes very 
few weeks of good training to produce good 
results in this matter, and very few weeks 
of carelessness to produce bad results. 

Care of the Baby^s Mouth — The baby's 
mouth should be washed thoroughly but 

32 



The Nursing of Children 

gently before each nursing. In theory, it 
should also be done after nursing, but 
in practice it does not seem quite rational to 
waken a baby who has just dropped oS to 
sleep. The point is to see that the mouth 
is kept clean, and it is easier and surer if a 
definite routine is established. Use a bit of 
absorbent cotton twisted about a toothpick, 
being sure that the point is well covered. 
The nurse's finger, no matter how gently 
used, may bruise the tender membrane of 
the mouth. 

The mother's nipples should be washed 
both before and after nursing, the washing 
afterward being the most important. Any 
excessive tenderness or the least suspicion of 
a crack should be at once reported to the 
physician. 

In cases of flat or retracted nipples a 
breast pump may be used to draw them out, 
or a shield employed to enable the baby to 
take hold of them. These appliances may 
usually be dispensed with if the baby be 
properly awake, properly placed and skil- 
fully handled. Very bad cases of retracted 
nipples may be successfully overcome by a 
good-tempered, wideawake baby. 

33 



The Nursing of Children 

Crying — ^The child's crying during the first 
few days is one of the most difla.cult matters 
with which the nurse has to deal. She must 
explain as best she can the reasons for it, and 
endeavor to quiet the mother's anxiety in 
regard to it. It is well to observe that the 
mother frequently worries less over crying if 
the baby is in her room and she can see what 
is being done. At night it is better that she 
be not disturbed and that the baby be cared 
for in another part of the house. In hospital 
practice babies are best kept at some dis- 
tance from the mothers' rooms or wards, but 
the mothers should be told that they may 
see them whenever they wish. A mother 
frequently wishes her baby kept near her, 
because she fancies it will not be brought 
when she requests it or that it may be neg- 
lected. Tact and the arousing of confidence 
are needed on the nurse's part to overcome 
this. Very few mothers object to their 
babies being kept in a nursery if the matter 
is properly presented. 

Crying may be from hunger. If there is 
apparently no milk in the mother's breasts 
and the child appears unsatisfied after an 
attempt at nursing, one may try giving 

34 



The Nursing of Children 

water, on the ground that relieving thirst 
and warming and filling the stomach may 
prove comforting. If one is convinced that 
the child is really hungry, the physician may 
be notified and food given under his advice. 
The nurse should take no responsibility in 
the matter of artificial feeding at any 
time. 

Crying may be due, even in the first few 
days, to colic. This may be relieved by 
copious draughts of warm water and by lay- 
ing the baby almost on its face over a hot 
water bag. If these expedients fail, an 
enema of warm water will usually be effec- 
tive. In a few cases crying may come from 
simple lonesomeness. Try turning the baby 
slightly, gently patting it, or even talking to 
it. It should not be taken up nor held. 



35 



PART III 

General Care of a Young Baby 

rjlEMPERATURE— As long as a nurse 
-^ has the care of a baby she should take 
its temperature twice a day simply as a 
precaution. In the morning just before the 
bath and at bedtime in the evening are con- 
venient hours. Use the rectal thermometer 
with a large bulb rather than the ordinary 
sharp-pointed one. Put oil or vaseline upon 
it, insert gently and hold carefully in place 
till it has registered. 

Take pains to teach the mother how 
to take temperature and explain to her 
its significance. Warn her against over- 
anxiety, teaching her that high temperature 
in a child means far less than in a grown 
person. 

Weight — ^The baby should be weighed 
regularly, even after it is thriving well. 
During the first month of life it should be 
weighed daily; after that once a week is 
sufficient. The weight should be observed 
without the clothing, simply because it is 
more accurate. If a towel is used inside the 

36 



The Nursing of Children 

scale, it should be allowed for. An ordinary 
grocer's scale will be found more accurate 
than the rather expensive ones usually sold 
for weighing babies. 

A weight chart should be kept for each 
baby. This is much like a temperature 
chart and gives a graphic picture of this all- 
important matter. 

Many nurses have no clear idea of the 
causes and meaning of the child's initial loss 
of weight. It is due to evaporation, to elim- 
ination, and to lack of food. It usually 
amounts to nearly a pound, but may be as 
little as half a pound or may run to one 
pound and a quarter. The amoimt lost is 
of less importance than the time over which 
it extends. The child should cease losing 
by the fourth or fifth day and should begin 
to gain by the end of a week. There may 
be no gain for several days without its being 
at all a serious matter, but if loss continues 
beyond the sixth day it is reason for anxiety. 
So, later, a child may not gain for several 
weeks without anything being radically 
wrong, but if he loses the matter should be 
taken vigorously in hand. 

Lifting and Handling — ^It ought not be 

37 



The Nursing of Children 

necessary to say that a baby should be 
handled carefully. Care means skill more 
than actual gentleness. A baby will be less 
injured by what seems like rough handling 
than by some well-meant but stupid mode 
of lifting. For example, there is nothing 
really wrong about picking up a child by its 
feet, but it is almost criminal to lift it by its 
arms. (Fancy how you yourself would like 
to be lifted from bed in this fashion.) 

To lift a baby properly, the head and back 
of the neck should be supported by one 
hand, while the other grasps the clothing at 
the feet or just below. When a child is 
lifted without its clothing, it should be 
grasped by the ankles, a finger being placed 
between them to avoid pinching. 

In dressing, do not lift the baby, but roll 
it, exactly as you would a grown person. 
All garments should be put on over the feet, 
never over the head; the latter method is 
injurious to both eyes and temper. When 
one garment can be slipped inside another 
and the two put on at one time, it should be 
done. 

Carrying — ^The correct and comfortable 
way to carry a baby is not the usual cramped 

38 



The Nursing of Children 




PROPER WAY TO HOLD BABY 

position in the arms, but it should be carried 
over the hip, face downwards, with the 
nurse's arm under its abdomen. This gives 
absolute freedom of movement and is easier 

39 



The Nursing of Children 

for both child and nurse. It has the advan- 
tage of leaving one of the nurse's hands free 
for the opening of doors, etc. The method 
is rather startling to the laity, but is the one 
taught in the best hospitals. It is equally 
convenient for carrying older children. 

Excretions — ^The nurse should familiarize 
herself with the character, amount and fre- 
quency of the baby's normal excretions and 
should teach the mother to recognize any- 
thing wrong. 

The urine should be practically colorless 
and odorless and the quantity considerable. 
If it be colored or scanty, give large amounts 
of water to drink, and the matter will right 
itself. 

The bowel movements should be bright 
yellow or orange in color, a soft, unformed 
mass. Tiny white curds are not abnormal, 
but if they are large and hard they should be 
shown to the physician. A formed or pasty 
stool, one pale in color, a green or watery 
stool or one containing blood should be re- 
ported. If the bowels move well once a day 
it may be sufficient. Five or six movements 
a day, if they are normal in appearance, need 
not occasion uneasiness. 

40 



The Nursing of Children 

Control of Excretions — Training in control 
of bowels and bladder may begin as early as 
the latter part of the first month. The child 
may be placed on a small jar or bowl at fre- 
quent intervals, as often as once an hour at 
first. Twice a day a small soap or glycerin 
suppository may be used, or the simple in- 
sertion of an enema tip may be sufl&cient to 
start the rectal reflexes. This training 
seems a slow process, but the child learns 
after a time to associate the position on the 
jar with the reason for it, and the trouble 
taken at first is well repaid by the lack of 
trouble later. Many instances can be cited 
where a baby rarely had a soiled diaper after 
the age of three months, nor a wet one after 
six months. 

Medicines — ^Laxatives, even the simplest, 
should not be given without the advice of 
the physician. The same rule should be 
made for all other drugs and for all sorts of 
teas, or, in fact, anything which is not food 
nor water. The practice of dosing the 
baby, even with harmless remedies, often 
lays the foundation for future stomach and 
intestinal troubles. 

Enemata — A simple enema may be given 

41 



The Nursing of Children 




PROPER WAY TO CARRY BABY 

upon the nurse's own responsibility. Warm 
water is usually sufficient, though a little 
weak soapsuds made from white soap may 
be used if it seems necessary. In cases of 

42 



The Nursing of Children 

diarrhea nothing is better than a cold 
enema, and the nurse may give this before 
she sends word to the physician. 

A convenient way to give an enema is to 
place the baby on a douche pan, with a firm 
pillow under the head and shoulders. This 
is comfortable for the child, and saves much 
soiling of clothing. 

Unusual Conditions — If the head is out of 
shape from a prolonged labor, the parents 
may be reassured in regard to it. No treat- 
ment is necessary, though some of the grand- 
mothers were taught that the head ought to 
be molded into shape. Such deformities rarely 
persist for more than forty-eight hours, and 
no harm is likely to result from them. 

Forceps marks, unless deep, need no 
attention. If the skin is broken, or there is 
much bruising or swelling, the physician's 
attention should be called to it. He may 
order a hot application or an ointment. 
Whatever substance is used should be sterile, 
as for any wound. 

Facial paralysis from forceps, even if con- 
siderable, usually lasts but a few days, and 
need occasion no alarm. 

Vomiting of brown material ordinarily 

43 



The Nursing of Children 

means that the mouth or nose has been 
bruised during delivery and the blood swal- 
lowed. It is not cause for alarm unless 
there are other symptoms of hemorrhage. 

Severe hemorrhages do occur during the 
first few days. If not checked shortly the 
baby may not survive a week* There may 
be hemorrhage from the mouth, nose, skin, 
stomach, umbilicus, intestines, etc. Astrin- 
gent applications may be ordered or hemo- 
static drugs given, but treatment is rarely 
satisfactory. Very little is known of the 
condition which produces these hemor- 
rhages, but they are considered infectious 
in origin. 

Hemorrhage from the vagina is not un- 
common. It should be reported, but no 
treatment is likely to be ordered unless the 
flow is profuse or long continued. This con- 
dition is incorrectly called menstruation. If 
a douche is ordered, it may be given with a 
small glass piston syringe. 

Hematoma, a collection of blood under 
the scalp from an injury during delivery, is 
best left alone. It may persist for months, 
but usually takes care of itself. 

Milk sometimes appears in the baby's 

44 



The Nursing of Children 

breasts during the first few weeks of life, 
more commonly among male children. It 
should be reported and a snug bandage may 
be applied, but the breasts should not be 
squeezed nor handled roughly. The nurse 
should watch for any marked enlargement 
or pinkish coloring, suggesting infection. 

The so-called "blue baby" is a child 
whose blood is imperfectly oxygenated. It 
was formerly supposed that the trouble was 
due to lack of closure of the foramen ovale, 
but it is now claimed that it is caused by 
obstruction of the pulmonary orifice. The 
condition is commonly fatal and if the child 
survives it is likely to always be frail. The 
treatment is utmost quiet and careful feeding. 

A more or less detailed report of the 
baby's condition should be made to the 
doctor each day, whether he asks for it or 
not. The physician assumes that the baby 
is doing well, unless the nurse informs him 
to the contrary. Any unusual condition 
should be shown to the physician, not sim- 
ply told him. As a preventive of misunder- 
standings, it is wise to have the doctor see 
the baby at each visit. Do not ask if he 
wishes to see it, but bring it in or call his 

45 



The Nursing of Children 

attention to it as a matter of course. Neg- 
lect in this may lay both doctor and nurse 
open to serious criticism in case anything 
goes wrong. 



46 



PART IV 

Feeding 

IF IT be essential for the welfare of the 
child that the prospective mother have 
congenial surroundings and a tranquil mind, 
it is quite as much so for the nursing mother. 
No mother should nurse her baby when she 
is grieved or very nervous or angry, as 
changes take place in the milk under these 
conditions which render it almost poisonous 
and may cause serious illness. Far better 
let the baby go himgry for a few hours than 
run such a risk. 

If nursing is delayed for any reason, be 
careful that the child does not overeat and 
indigestion result. 

Quality and Quantity of Milk — Drugs 
taken by the mother frequently affect the 
child, notably cathartics. Saline cathartics 
diminish the amoimt of milk quite notice- 
ably, and the same thing occurs if the 
mother takes little fluid. Food which is 
nourishing and easily digested helps to in- 
crease the flow of milk, and is to be preferred 
to such things as tea, malt, beer, etc. A 

47 



The Nursing of Children 

nursing mother should have plenty of fresh 
air, day and night, and should take some 
outdoor exercise each day. 

The child should never nurse from an 
inflamed breast. It adds to the irritation 
already present in the mother and may 
injure the child's digestion or its general 
health. 

Night Nursing — It is a somewhat common 
practice for the baby to remain in bed with 
the mother a part or all of the night. If he 
is wakeful, as he is likely to be, she gives him 
the breast. This practice tends to make 
nursing more or less of an amusement, and 
the habit of nursing most of the night is 
soon formed; it injures the baby's digestion, 
renders the mother nervous and makes her 
unfit to nourish him properly. In ordinary 
cases there is no need of night nursing after 
the first month, and some properly trained 
babies sleep all night from the time they are 
born. 

Testing Milk — It should be borne in mind 
that quantity of milk does not necessarily 
imply quality, and that a child may be 
improperly nourished when the milk supply 
is ample. It is not out of place for a nurse 

48 . 



The Nursing or Children 

to suggest this to the physician, in order 
that an examination may be made by a 
competent chemist. One test alone may 
not be reliable, as the milk varies one day to 
the next, is poorer in quality when the 
mother is tired or worried and vice versa. 
The milk varies, also, at the beginning, end 
and middle of the nursing period, and a 
specimen should therefore include as much 
milk as can be drawn from the breast at one 
time. 

Sterilize a breast pimip and a bottle. 
Wash the breast well with boric solution, 
draw the milk with the sterile pump, empty- 
ing it directly into the bottle. Send the 
bottle to the laboratory, corked with sterile 
cotton. Tests are made for the reaction 
(whether acid or alkaline), the amount of 
fat, the total amount of solids, etc. 

Wet Nursing — If the mother's milk does 
not agree with the child or is insufficient, and 
if persistent efforts to improve conditions 
are not successful, a wet nurse may be ad- 
vised. Wet nurses present many difficul- 
ties, but they frequently save a life. It goes 
without saying that a wet nurse should be a 
healthy woman and neither too young nor 

49 



The Nursing of Children 




FEEDING BABY IN CRIB 

too old, from twenty-five to thirty-five being 
the age of choice. She should not be asked 
to change her mode of living very materi- 
ally; a woman accustomed to simple food 
and an active life may be upset by living a 
sedentary life or eating rich food. If possi- 



The Nursing of Children 

ble, see that a nurse is selected whose baby 
is near the age of the patient, as the milk 
varies from month to month; this may not 
be a vital matter, however. If the wet 
nurse is feeding her baby along with her 
foster child, it is well to be sure that she is 
not depriving the one of food which the 
other needs. Both may be partially bottle- 
fed in ordinary cases. 

In the matter of feeding, no nurse can 
conscientiously advise anything but breast 
milk. Living food contains enzymes, fer- 
ments, not found in any dead food, which 
mean much to the weak digestion. Lives 
have been lost by lack of insistence upon 
this vital point. 

Artificial Feeding — There may be, how- 
ever, good and sufficient reasons for resort- 
ing to artificial feeding. If the mother is 
tuberculous, in generally poor condition, 
extremely nervous, has an uncontrollable 
temper, etc., and a proper wet nurse cannot 
be secured, the nurse may concur with the 
physician's advice. The mother need not 
feel that the change is necessarily a calamity, 
but may be encouraged to see its advan- 
tages. Artificial feeding is undesirable, 

51 



The Nursing of Children 

of course, but may not be an unmixed 
evil. 

Habits — A word may be said here about 
methods of feeding. With children, as with 
adults, improper mastication, too rapid eat- 
ing, too frequent or too hearty meals are 
injurious. If regular habits in these mat- 
ters are not established early in life, the 
digestion will probably always suffer. 

Start, therefore, the first week, to teach a 
child that eating is a business, not an amuse- 
ment. Have it industriously and system- 
atically attended to, then dropped out of 
mind. Industry must be insisted upon, or 
many children will dawdle over food or play 
with it, forming habits which are both 
annoying and injurious. A breast-fed baby 
should be kept awake and nursing for the 
required time, and the same remark applies 
to a bottle-fed baby. If this habit is formed 
during the first few months, it will be very 
little trouble to have it continued. On the 
other hand, a child should not be allowed to 
eat too rapidly, to take food in large quanti- 
ties at a time. If food is not well mixed 
with saliva it is a serious omission, as this 
secretion plays an important part in diges- 

52 



The Nursing of Children 




FEEDING BABY IN NURSE'S LAP 



tion, especially of the starchy foods. Even 
with small infants, before the saliva becomes 
a factor in digestion, rapid eating causes 
indigestion, or at the least regurgitation. 
In feeding a bottle baby, do not leave the 

S3 



The Nursing of Children 

child alone in its crib. Even if a bottle 
holder is used, the baby is likely to move or 
the bottle to slip; the milk may run too fast 
or too slowly, or the baby may fall asleep. 
The child should lie in the crib, being placed 
slightly turned on its side, while the nurse 
sits beside it and holds the bottle; or the 
child may be held in the nurse's lap, while 
she holds the bottle at such an angle that 
the contents will flow properly and continu- 
ously. If the nurse lacks the time to do 
this, the mother or some other person may 
attend to it. Wrap the bottle so that the 
food may remain warm; a flannel or 
knitted wool cover made to fit the bottle is 
best. 

Kind of Food — ^The authorities still dis- 
agree as to what is the best artificial food 
for babies, and a nurse can, therefore, be 
only an unprejudiced observer. As a mat- 
ter of fact, no one food will suit all infants, 
and that which is best in theory may not 
be so in practice. Sometimes, also, a child 
will thrive in spite of its food, not because 
of it. Under no circumstances should a 
nurse suggest any particular food. Her 
work is to see that the food is properly pre- 

54 



The Nursing of Children 

pared and given, to make careful observa- 
tions and to report existing conditions. 

In the matter of proprietary and patented 
foods, a nurse must be conservative. Nearly 
all of these preparations are deficient in pro- 
teid, the muscle-making and tissue-building 
element, and contain an excess of sugar and 
fat-forming constituents. Children fed upon 
them gain in weight, but the flesh is fat 
rather than muscle; while these children are 
apparently healthy, they succumb more 
readily to disease than those brought up on 
a more natural food. A nurse must be 
unprejudiced, for there are many cases 
where milk foods cannot be used, and one of 
these substitutes may tide over a critical 
period. 

There is one point of vital importance 
which a nurse should lose no chance to 
impress. The child which is fed upon milk 
foods only for its first year has a much 
better chance of life and health than one 
partially fed on something else. Absolutely 
nothing but milk foods are to be given for 
the first ten months, and if they are con- 
tinued until the end of the year so much 
the better. 

55 



The Nursing of Children 

Preparation of Food — Whatever food is 
used should be prepared with exactness and 
scrupulous cleanliness. Reliable measures 
should be provided and used. Bottles 
should be washed immediately upon being 
emptied, with boiled water, or that known 
to be pure. All utensils used in the care or 
preparation of the food are best boiled once 
in twenty-four hours. Almost the only 
appliances needed are an eight-ounce gradu- 
ate, a small cream dipper, and a glass tube 
bent into a U-shape, to be used as a siphon. 
A large bottle or ten small ones will be 
needed for keeping the food. 

The sort of nursing bottle does not matter 
particularly for a very young baby, except 
that a straight bottle without a neck is more 
easily kept clean. The nipples used should 
be short, as the usual type goes too far back 
into the baby's throat. The nipples should 
be washed immediately after using, and kept 
in a solution of boric acid. They may be 
boiled on alternate days, as too frequent 
boiling ruins the rubber and makes the 
nipple collapse. 

Modified Milk — ^This is the nearest ap- 
proach to human milk which is obtainable, 

S6 



The Nursing of Children 

providing it is properly prepared. In this 
country we use cows' milk as a foundation, 
though it should be remembered that it is a 
food which Nature intended for calves, 
creatures much coarser in structure and 
more rapid in development than human 
babies. It is in itself too strong and too 
coarse a food and must, therefore, be con- 
siderably diluted and modified to be 
digested. In a general way, cows' milk 
contains more proteid, less fat and less 
sugar than human milk. 

In the few cities where Walker- Gordon 
laboratories exist, and where there are 
physicians familiar with the laboratory 
preparation of milk, one naturally takes 
advantage of these thoroughly scientific 
facilities, but usually it becomes necessary 
for the nurse to make a home modification. 
If her teaching and experience in this work 
are deficient, she should, at any rate, 
familiarize herself with the theory of it. 
The books by Holt and by Fischer give 
much help. Rotch is considered an author- 
ity. Cotton and DeLee are very useful, also 
Friedenwald and Ruhrah, in their book on 
"Dietetics. " 



57 



The Nursing of Children 

A formula should not be expressed in 
terms of "milk," "cream/' etc. Milk may 
mean whole milk, skimmed milk, or some- 
thing between the two. Cream obtained by 
skimming a pan is one thing, that taken 
from a bottle is another, and that separated 
by a machine is still another. Insist upon 
an exact specification of what sort of milk 
and cream is to be used. 

Holt's formulae read something as follows: 

io% milk (or 7% milk). 

Milk sugar. 

Lime water. 

Boiled water. 

The milk sugar may be bought of almost 
any druggist, but one should buy a standard 
make in its original package, rather than 
purchasing in bulk. Cane sugar is pre- 
ferred by some doctors, and if this is used 
the quantity required is less. Lime water 
may be made at home or bought at the 
druggist's. If home made, care should be 
taken to filter it thoroughly through cotton, 
as any particles may be harmful. 

Ten per cent, milk means the upper third 
of a bottle of milk which has stood for four 
hours or a little more. Seven per cent, milk 

58 



The Nursing of Children 




NURSING BOTTLES 



means the upper half of a bottle which has 
stood for four hours or a little more. This 
top milk cannot be obtained by pouring it 
from the bottle, but must be removed by a 
small cream dipper or a siphon. There are 
good cream dippers to be bought in the 
stores or any tinsmith can make one from a 
wire and a semi-circular piece of tin. The 
siphon may be glass or simply a rubber tube. 
Several devices are available which sim- 
plify the mixing of modified milk. The 
Estrans ^^Materna" graduate glass, holding 

59 



The Nursing of Children 

sixteen ounces, has seven sides or panels, 
upon six of which are marked the exact 
amount of each constituent for any given 
modification. The six different formulae are 
supposed to be used successively, as the 
baby grows older and requires a different 
food. Dr. Westcott, of Philadelphia, has 
devised a chart with two revolving disks, so 
arranged that by turning the disks the 
relative quantities of each ingredient are 
shown. 

Preparation of Modified Milk — ^The milk 
sugar should be dissolved in hot boiled 
water; if the solution is not clear, strain it 
through fine cloth or absorbent cotton. To 
this solution may be added the lime water, 
boiled water and milk, one at a time, stirring 
well. It is wise to scald all utensils just 
before using, to be sure of their cleanliness. 
If the milk is not to be pasteurized or ster- 
ilized, it should be put immediately into 
sterile bottles, large or small, as the case 
may be, corked with absorbent cotton and 
placed immediately upon the ice. 

It is best to prepare a quantity sufficient 
for twenty-four hours. Ten feedings will be 
required for a young baby and fewer for an 

60 



The Nursing of Children 

older one. The quantity in each bottle will 
be prescribed by the physician, and varies 
from two ounces for a young baby to ten or 
even twelve ounces for a year-old child. If 
the entire quantity is placed in one large 
bottle, it should be shaken each time before 
any is taken out. 

Always heat the milk to blood tempera- 
ture before giving it to the baby. This 
should be done by setting the bottle in 
warm water, never by pouring the milk into 
another vessel. The temperature of the 
milk should be tested by pouring a few 
drops on the back of the hand. 

Sterilization — If the milk is ordered steri- 
lized, it may be done by setting the bottles 
in a deep pan of water and boiling for one- 
half hour, then placing immediately upon 
ice. Sterilized milk is rarely ordered nowa- 
days, as it is claimed that complete steri- 
lization kills the ferments which are needed 
to insure proper digestion, literally ^'taking 
the life out" of the food. 

Pasteurization — This is commonly prac- 
tised, as the process kills most of the harmful 
germs without destroying the ferments. In 
order to accomplish it, the milk must be 



The Nursing of Children 




MATERNA GLASS 



heated to about i6o° F. and kept at that 
point for about one-half hour. This is best 
done by means of a special apparatus, but 
may also be accomplished in a fairly satis- 
factory manner, if a thermometer is used, 
and the process carefully watched. Unless 
milk has been handled with the greatest of 
care, i.e., is *^ certified" milk, it is wise to 
pasteurize it. 
Clean Milk — Much has been written and 

62 



The Nursing of Children 

said about wholesome milk and the proper 
care of it. The old-fashioned dairy will 
soon be a thing of the past and the modern 
sanitary one will be the only thing tolerated. 
It is well known that milk is more easily 
contaminated than almost any other food, 
and that germs of all sorts grow in it very 
readily. It therefore needs the utmost care, 
both of cows, stables, utensils, milkers' 
hands, etc. The best dairy farms employ 
methods copied from the operating room 
and maintain a cleanliness which is practi- 
cally surgical. Besides this utter cleanli- 
ness, the milk must be cooled rapidly and 
thoroughly to prevent the growth of any 
bacteria which may still be in it. 

The general condition of the cow from 
which the milk is obtained is obviously im- 
portant. Cows are specially prone to tuber- 
culosis, and should be tested often enough to 
make sure that it is not developing. The 
Holstein cow is considered the best for pro- 
ducing milk for babies, as this breed of cow 
is less prone to disease than others, and the 
milk, while somewhat less creamy, contains 
more proteid. The Jersey is not thought to 
be a good cow for obtaining milk for babies. 

63 



The Nursing of Children 





DIPPERS AND SIPHON 

Milk from a herd of cows is better than that 
from an individual, as it is less likely to vary 
from day to day, and any peculiarities are 
less noticeable. 

Special Preparations — Peptonized milk is 
sometimes ordered when the child's diges- 
tion is feeble. This may be done with the 
so-called "peptonizing tubes/' or with pep- 
togenic milk powder. In either case, exact 
following of the printed directions is neces- 
sary. Prepared by the cold process, only a 
partial peptonization takes place, but this is 
sufficient in most cases, and the milk is ren- 



64 



The Nursing of Children 

dered more palatable than when it is done 
by the aid of heat. Peptonized milk is 
usually only prescribed as a temporary food. 
Parents should be informed that it must not 
be continued more than a few months with- 
out expert advice. 

If the child is inclined to constipation, 
oatmeal water or gruel or oat jelly may be 
used to dilute the milk instead of boiled 
water. Oatmeal is decidedly laxative in its 
action, but the exact amount to be used 
must usually be determined by experiment 
with each individual case. If made from 
oatmeal, the meal should be soaked over 
night in cold water. If from rolled oats, 
this is unnecessary. In either case the oat 
preparation should be put on in cold water 
and heated gradually, then allowed to cook 
slowly for an hour or more. After thorough 
cooking, it is to be strained through fine 
cloth while still hot. It should be thick 
enough to jelly when it becomes cold. This 
jelly or gruel should be kept on ice until it 
is used. If less laxative effect is desired, 
oatmeal water — simply a thin jelly — may be 
used. 

If there is a tendency to diarrhea, barley 

65 



The Nursing of Children 

or rice water may be used with the milk. 
Rice water is made much as oatmeal water 
is, by a thorough cooking of the grain. Bar- 
ley water may be made in the same way, but 
it is usually more convenient to make it 
from barley flour (Robinson's is the 
best), using a tablespoonful to a pint 
of boiling water, and cooking for twenty 
minutes. 

Barley gruel alone may be prescribed 
temporarily when milk does not agree. 
This should be made thick. Beef juice is 
sometimes given with it, in the proportion 
of ten drops to an ounce of barley gruel for a 
very young baby, to a teaspoonful per ounce 
for an older child. This combination is very 
satisfactory in cases of dysentery or cholera 
infantum. 

Whey is sometimes prescribed, especially 
with premature babies or with those whose 
digestion is weakened by disease. It may 
be given alone or have cream added to it. 
To make it, heat one quart of either whole 
or skimmed milk to ioo° F., remove from 
the fire and add two drams of essence of 
pepsin or liquid rennet, stirring only enough 
to mix well. This will coagulate the casein 

66 



The Nursing of Children 

of the milk into the form of a curd, which 
whien cool may be broken up with a fork. 
The whey is the fluid which remains and 
contains the more easily digested constitu- 
ents of the milk. If cream is ordered given 
with it, the rennet enzyme must first be 
killed by heating to a temperature of 1 50° F., 
but it must not be allowed to go over 155° F. 



67 



PART V 

Feeding of Small Children 

SET it down as a first principle that if a 
child is properly fed he will be well. 
Excepting accidental injuries and conta- 
gious diseases (both of which are among the 
unusual things of life), practically all chil- 
dren's illnesses are traceable to their diges- 
tive organs. This makes the matter of 
feeding little children a very vital thing. 

When your opinion is sought as to whether 
this or that article of food will "hurt'' a 
baby or small child, the only safe and sensi- 
ble ground to take is that one should limit 
a child's diet to what one knows to be whole- 
some, rather than to take chances with 
things which are questionable. Not often 
can an illness be traced to a definite indis- 
cretion, but it is usually very easy to trace 
it to repeated indiscretions. Nature bears 
a great deal of ill treatment, but finally 
enters her protest. There is no wisdom in 
pushing her to her limit. 

Quantity of Food — Most physicians agree 
that ordinary people, including children, eat 

68 



The Nursing of Children 

too much. Certain it is that few people eat 
too little. A healthy child can take care of 
an excess of food, but why tax him to that 
extent ? He needs supervision in his eating, 
chiefly to see that he takes enough of that 
which has a food value, rather than a quan- 
tity of material which may be ^^ filling,'' but 
contains little nourishment. For example, 
a cupful of bread and milk may be quite 
worth while, but a large slice of watermelon 
has practically no food value. 

Number of Meals — During the second and 
third years of life a child should have five 
meals a day. Something should be given 
him soon after waking in the morning, as 
children are usually hungry at this time. 
The following is a good schedule for a baby 
beginning his second year: 

7 A.M. — A cupful of warm milk, one- 
fourth being gruel. 

lo A.M. — Eight ounces of warm milk and 
gruel. 

I P.M. — Eight ounces of broth (beef , veal, 
mutton or chicken) or yolk of lightly boiled 
egg with bread crumbs. 

4 P.M. — Eight ounces of milk with gruel. 

69 



The Nursing of Children 

7 P.M. (or bedtime) — Eight ounces of 
milk. 

Orange juice up to the amount of two 
tablespoonfuls may be given about 9.30 
A.M., especially if there is any tendency to 
constipation. 

As the second year advances, it is advis- 
able to add more substantial articles, but 
those known to be easy of digestion, such as 
beef juice, egg albumen stirred with cold 
water or milk, well-cooked rice, thoroughly 
baked white potato, sago, gelatin, corn- 
starch, tapioca, custards, junket, stewed 
apples, prune juice, the pulps of seeded 
grapes, ripe bananas rubbed through a sieve 
and served with cream, or even scraped beef 
or well-cooked fish. 

From the fourth year on, three meals a 
day should be the rule. This should not 
prevent one's giving a hungry child a light 
lunch between meals, if the occasion de- 
mands. When a child has been 'Splaying 
hard," i.e., taking active physical exercise, 
and is willing to drink a glass of milk, a cup 
of broth or cocoa, or eat a slice of bread and 
butter, it should not be denied him. If his 
appetite calls for cake, cookies, preserves, 

70 



The Nursing of Children 

candy, etc., one may with reason insist that 
he wait until meal time. 

If a child complains of hunger at bedtime 
or in the night, and is content with a glass 
of milk or some small crackers, they should 
certainly be given. 

Food Values — In childhood, even more 
than in later life, a balanced ration is import- 
ant. Children must be provided with not 
only the material to supply the daily waste 
of muscle, blood, fat, heat and energy, but 
must have material to use in growth. They 
must have food constituents which will 
make bone, muscle, blood, fat, tendons, 
blood vessels, teeth and all organs. These 
must be supplied in such a form as not to 
overtax the organs of digestion and as- 
similation, nor clog the organs of elimi- 
nation. 

Classes of Food Required — ^There must be 
proteid, for muscle and energy; such food 
as meat, fish, grains, cereals, milk, eggs, dry 
peas and beans. 

There must be carbohydrates, for heat and 
energy, such as the starches and sugars 
which are found in all grains, fruits and 
vegetables. 

71 



The Nursing of Children 

There should he fats and oils, for heat and 
energy, such as cream, butter and vegetable 
oils, though less of these is required in warm 
weather. 

There should be the mineral salts, for 
bones, teeth, brain, etc., as contained in 
fruits, vegetables and water. 

Milk is nearly a perfect food, and bread 
and milk could be used for a child's diet 
without any addition. Modern conditions, 
however, make it desirable to have the diet 
more varied. Most children require some 
fruits or vegetables for their laxative effect, 
as well as for their mineral salts. Fortu- 
nately, the appetite of a healthy person is a 
pretty good guide, and even in illness 
nature gives us a good many suggestions 
about diet if we will heed them. 

A goodly amount of fluid should be taken 
by children, avoiding only large quantities 
at one time. The tendency is to take too 
little, and there is not much likelihood of a 
child drinking too much water or milk if he 
takes it slowly. 

Necessity of Supervision — It should be 
remembered that children are extremists, 
and that self-control has not yet been 

72 



The Nursing of Children 

learned. They should therefore be given 
guidance as to quantity and quality of food, 
should not be allowed to indulge too freely 
in a favorite food nor. to neglect articles 
needed to make a balanced ration. A 
healthy child may be allowed to follow his 
appetite largely, and if he insists that he is 
not hungry it is better not to urge food upon 
him; the digestive organs may have been 
unwittingly overtaxed and nature be en- 
deavoring to correct the difficulty. A sick 
child, of course, needs more restraint or 
encouragement. 

Individual Requirements — Mothers and 
nurses should realize the close connection 
between careful feeding and health in indi- 
vidual as well as general cases. A child 
may be allowed a more varied and hearty 
diet if he lives outdoors and romps and plays 
there in all sorts of weather. The child 
whose circumstances debar him from such a 
life will have a more delicate digestion and 
must be more carefully watched. Family 
tendencies and heredity should be studied, 
that the balance of power may be thrown on 
the side of health. If there is tuberculosis 
in either father or mother, make meat, 

73 



The Nursing of Children 

eggs and milk the basis of the diet. If there 
is a tendency to fermentative dyspepsia, 
starches and raw fruits should be eaten 
sparingly, and meats, eggs and green vege- 
tables be the diet. If there is irritation of 
the kidneys or fear of Bright's disease, very 
little meat should be eaten. Scant, acid 
urine also calls for a reduction of meat. 
The common tendency to constipation may 
be counteracted by large amounts of fluid, 
especially warm fluid, rhubarb, prunes, 
cooked apples, peaches, grape juice, orange 
juice, dates, figs, tomatoes, coarse breads 
and cereals, green vegetables, olive oil and 
honey. 

Cooking — It may be that raw food would 
be appropriate were we living in ^'a state of 
nature,'' but under civilized conditions there 
is no doubt that cooking is an important 
factor in the proper preparation of food. 
Children in particular do not masticate hard 
food well, may be unable or imwilling to do 
so. Such things as raw cabbage, radishes, 
celery, cucumbers, beets, corn, etc., are 
therefore not suitable food for children; 
even when cooked, they are still not much 
better. 

74 



The Nursing of Children 

On the other hand, meat, fish, potatoes, 
beans, peas, and some of the fruits are ren- 
dered wholesome by cooking. We find 
some form of cooking necessary to secure 
variety and digestibility. 

Again, improper cooking may convert a 
wholesome food into an indigestible sub- 
stance. This is notably true of fried foods, 
as the portion which has been hardened 
while in contact with the hot grease is 
scarcely attacked by the digestive juices at 
all. Certainly children's digestive organs 
should not be taxed with such things as 
fried meat or vegetables, fritters, hot cakes, 
etc. 

Cleanliness — Absolute cleanliness should 
be the rule in the kitchen. We have 
learned that a clean dairy is necessary to 
insure wholesome milk. So we must learn 
that a clean kitchen and a clean refrigerator 
are necessary to insure wholesome food. 
Cooking utensils should be of granite or 
aluminum, and should be properly washed 
and well scalded. Dish cloths should be 
wholesome and dish towels clean. The 
cook's hands and dress should be kept clean. 
Vegetables and fruits which are to be served 

75 



The Nursing of Children 

raw should be plunged into hot water to free 
them from germs, then put quickly into cold 
water to secure crispness; they should not 
be allowed to soak in water until the flavor 
is spoiled. 

Serving — Children are quite as sensitive 
as grown persons to the manner in which 
food is served. They may not appreciate 
the refinements of linen, china and manners, 
but daintiness certainly has its effect upon 
them. A small quantity of meat on an 
attractive plate, a ^^ cunning'' rounded pile 
of potato, gelatin from a mold rather than a 
spoon, a few ounces of broth or cocoa in a 
dainty cup, bread in sticks or strips instead 
of a slice, thin sandwiches instead of plain 
bread, an egg in a small cup or a tiny bak- 
ing dish, all serve to render food attractive 
to little people. 

With well children any attraction should 
not be allowed to interfere materially with 
the business of eating; but with sick chil- 
dren, where appetite is capricious or lacking, 
there is great justification in making a play 
of the matter. Houses may be built of 
strips of toast; farmyards surrounded with 
pieces of bread and dates, figs or prunes 

76 



The Nursing of Children 

placed inside for the animals; lakes can be 
made of cereal, with milk in place of the 
water; caves can be built of mashed potato, 
and many other attractive things can be 
devised by the nurse who puts her mind to it. 

Variety — It is generally conceded that 
variety is desirable as far as it is needed to 
make a balanced ration. The average child 
will be content with a rather monotonous 
diet, while grown people, especially in 
America, eat too many kinds of food at a 
meal and demand variety for variety's sake 
rather than for any real need. Attempt to 
get variety often results in unwholesome 
combinations. Study the things which the 
best cooks serve together and you will find 
them scientifically correct. 

There is an advantage in teaching a child 
to like many sorts of food, since circum- 
stances may arise when it becomes necessary 
for him to eat things to which he has not 
been accustomed. It is wise to insist that a 
child take at least a taste of any new food 
which is presented to him, providing, of 
course, that it be wholesome. 

A child of three years may have a daily 
dietary somewhat as follows: 

77 



The Nursing of Children 

Milk, cui libitum. 

Cream, 4 to 6 ounces. 

Meat broth with rice or barley, vegetable 
or cream soup. 

Bread with every meal (this may include 
some variety, as rye, graham, whole wheat, 
rusk, zwieback, etc.). 

Fruit once or twice a day (baked apples, 
oranges, peaches, pears, or grapes, if mature 
and carefully selected, not over-ripe). 

Cereals for breakfast, dry or cooked. 

Meat for dinner (lamb, beef, mutton, 
chicken). 

Vegetable for dinner (peas, beans, pota- 
toes'—creamed or baked, spinach, asparagus, 
cauliflower, lettuce, etc.). 

Dessert for dinner — custards, cornstarch, 
junket, gelatine, ice cream, simple pud- 
dings. 

Older children may have biscuits or muf- 
fins, melons, plain cake, cocoa and chocolate, 
salads and salad dressing, and simple home- 
made candy at the end of a meal. Eggs are, 
of course, always allowable, if they are not 
fried. 

Rotch believes that meat may be given 
early in the second year, using chicken, mut- 

78 



The Nursing of Children 

ton chop, roast beef and steak. Other 
authorities consider it better to postpone 
meat as long as possible, or even to omit it 
altogether. There is no doubt but that 
healthy persons, whether young or old, can 
get on without meat, providing only they 
take a sufficient quantity of proteid food in 
its place. This is somewhat a matter of 
taste and circumstance and may be left to 
be worked out for each individual. 

Rotch advocates a considerable variety of 
food as early as the age of two and a half, 
suggesting a good deal of fruit, and vege- 
tables, such as squash, string beans, young 
peas, spinach, etc. 

Lewis forbids the following articles for all 
young children: Ham, sausage, pork in any 
form, kidney, liver, meat stews, salt fish, 
dried beef, canned meats, game, duck, goose, 
dressing from roast meats, all hot breads or 
rolls, fried vegetables, griddle cakes, raw or 
fried onions, cabbage, carrots, radishes, raw 
celery, cucumbers, beets, tomatoes raw or 
cooked, corn, eggplant, and potatoes, except 
when boiled or roasted; all cake, except the 
very plainest; salad, pastry, jelly, preserves, 

79 



The Nursing or Children 

dried fruit, bananas, nuts, candy, tea, coffee, 
cocoa, wine, beer, etc. 

This makes a very restricted list and some 
of the items seem harmless enough. It is 
well to err always on the safe side and wiser 
to limit a child's diet too much than to urge 
him to a variety which may be harmful. 

To summarize: 

Remember the importance of the child's 
food, his need of material by which to grow, 
and the fact that children's illnesses are 
usually of digestive origin. 

See that a balanced ration is provided. 

See that food is cooked in a cleanly and 
proper fashion, and served in an attractive 
manner. 

Provide sufl&cient variety for health and 
for emergencies. 

See that food is properly eaten. 

Omit all questionable foods. 



80 



PART VI 

Premature Babies 

THERE are several causes for babies 
being born prematurely, disease or over- 
work on the part of the mother being the 
most common. Shock is also a factor in 
some cases. 

Nurses should combat the notion that pre- 
mature children will not develop mentally 
as well as full-term ones, since this has been 
disproven. They should also contradict the 
popular idea that a seven-months baby sur- 
vives when an eight-months one does not, 
as this has no foundation either in science or 
in fact. 

It is almost impossible to determine the 
exact amoimt of prematurity, and any state- 
ments concerning this matter should be 
given with extreme caution. Most authori- 
ties agree that an infant does not survive if 
born before it has passed the twenty-seventh 
or twenty -eighth week of intra -uterine 
life. 

The Child's Handicaps — The premature 
child's three handicaps are lack of subcuta- 

8i 



The Nursing or Children 

neous fat, lack of lung development, and 
feeble digestive powers. 

Because of its lack of fat (which is formed 
almost entirely during the later weeks of 
pregnancy), radiation of body heat takes 
place very rapidly, vitality is lowered and 
all functions interfered with. For this 
reason the child must be kept warm from 
the moment of birth, or it may die simply 
as the result of chilling. 

During fetal life most of the organs are 
working to a degree, but this is not true of 
the lungs; they are therefore behind the rest 
of the body in development and often fail to 
unfold properly at birth and permit the air 
to penetrate. It is the nurse's duty to see 
that the baby cries vigorously at birth; neg- 
lect of this may cost the child its life, because 
the blood will not be perfectly oxygenated 
to begin with, and the matter grows worse 
from day to day. 

The digestive organs, being not yet ready 
for use, are feeble. The nourishment given 
must therefore be of such a character as to 
be easily assimilated, and the time and 
amount of feeding should be observed with 
great care day and night. 

82 



The Nursing of Children 

The temperature of a premature infant is 
usually subnormal until it begins to gain in 
weight, when it may go above normal. A 
continuous subnormal temperature is a 
grave symptom. 

Cyanotic attacks may occur early or at 
any time. For these two or three drops of 
brandy or whiskey in a half-dram of warm 
water may be given by mouth or by rectum, 
preferably the former, as it is more rapid 
and certain. Fainting may occur from a 
slight disturbance; for this reason, it is well 
to keep the baby in a horizontal position. 
Oxygen in small quantities may be given 
when there is imperfect respiration and 
usually helps. Convulsions may be met by 
the giving of a mustard bath or pack. For 
the mustard pack, wring a cloth out of 
strong mustard water (a teaspoonful to a 
pint) and wrap it about the child, at the 
same time placing a cool cloth upon the 
head. 

The most frequent causes of death in pre- 
mature babies are disturbed heart action 
and lung insufficiency. 

Preparation and First Care — When a pre- 
mature birth is inevitable, the delivery room 

83 



The Nursing of Children 

should be heated to 80 degrees or over, and 
a basket or crib provided, which shall be 
heated by means of hot water bags or bot- 
tles. Extra help should be secured so that 
the baby may be looked after promptly. 
The maintenance of bodily heat is of first 
importance. 

Many devices have been used to keep pre- 
mature infants sufficiently warm. An old 
peasant custom was to place the child in a 
jar of feathers. Winckel used a continuous 
warm bath. A box nearly closed, heated 
with hot bottles, has frequently been used. 
Some large hospitals, notably Bellevue, of 
New York, keep their premature babies in a 
small hot room. Other authorities insist 
upon the modern style of incubator. 

Incubators — ^The chief faults in the old- 
fashioned, crude incubators were their irreg- 
ular heat and their lack of ventilation. The 
modern forms have overcome these difficul- 
ties to a great extent. They are provided 
with a heating arrangement controlled by a 
thermostat, and with ventilating apparatus. 
The criticisms upon them are due chiefly to 
defects in these two things. While presum- 
ably automatic, they must be closely 

84 



The Nursing of Children 

watched, as the ventilating apparatus does 
not always work, particularly in warm 
weather, and the thermostat may be dis- 
arranged by an accumulation of dust or 
rough handling. 

The advantages of an incubator are: Even 
heat from hot water or electricity; fresh air 
warmed before it reaches the child; means of 
regulating the moisture of the air. Some of 
the newer patterns have a scale attachment 
so that the baby may be weighed without 
removing it from the incubator, 

A nurse must be in constant attendance 
upon an incubator baby. She must see that 
the ventilating fan at the top is moving; 
must note the thermometer to insure con- 
trol of heat; must see that the hygrometer 
stands at normal and, if necessary, dampen 
the air by means of a saucer of water set in 
the incubator or by a wet sponge or piece of 
gauze h\mg inside. She must see that all 
excretions are promptly removed, as the 
high temperature causes them to decompose 
rapidly. She must attend to the feeding 
with regularity and promptness. 

Value of Incubators — Crede and Tamier 
were among the first to make public their 

85 



The Nursing of Children 

opinion as to the value of the incubator. 
They are warmly in favor of it, and Tarnier 
published statistics which prove its effi- 
ciency. Holt and Edgar, who are authori- 
ties in this country, are skeptical as to its 
value. DeLee, who has had much experi- 
ence and is equally good authority, consid- 
ers the incubator essential in the care of 
premature babies. 

When to Incubate — Practically all authori- 
ties agree that any infant weighing 3^ 
pounds or less should be put into some sort 
of an incubator. Cooke advises the incuba- 
tion of all under 4}^ pounds. The enthusi- 
asts say all under five pounds. The doubt- 
ers would not incubate any child which 
seems to have a fair chance of life without it. 
The facts seem to indicate that a healthy 
baby of four pounds weight can usually be 
cared for without an incubator. 

The points to be considered are the child's 
weight, rather than the supposed amount of 
prematurity, and its general condition. 
These things cannot be determined by any 
fixed rule, but must be left to the individual 
physician. 

Essentials of Care — Edgar and Sherman 

86 



The Nursing of Children 

consider keeping up the bodily heat as the 
prime factor of importance. Cotton also 
lays emphasis upon this and advises feeding 
a milk sugar solution which is easily digested 
and is heat-producing. DeLee emphasizes 
feeding and considers mother's milk an 
essential. He insists upon early feeding. 
Holt and Rotch would delay feeding until 
the second day of life, whereas DeLee begins 
at once. The nurse will, of course, follow 
her doctor's directions, making her own 
observations. 

Location of Incubator — ^The incubator 
should be located in a room which is capable 
of thorough ventilation. The doors and 
window of the incubator are opened fre- 
quently and the air which enters should be 
pure. Provision must be made to admit air 
directly from out of doors into the incubator. 
In a building not specially arranged for this, 
a board may be placed under a partly opened 
window and a hole cut in it to receive the 
ventilating pipe from the apparatus. The 
room used should be on the sunny side of the 
building, but the apparatus should be shaded 
from strong light. 

Temperature of Incubator — The thermom- 

87 



The Nursing of Children 

eter should be hung above the child's head, 
never placed in contact with any metal. 
The amount of heat provided will depend 
upon the size, vitality and age of the child. 
It must be remembered that before birth a 
child has been in a temperature of nearly 
ICO degrees. A very small baby (one under 
3/^ pounds) may require a temperature of 
95 degrees. Cotton advises 88 to 90. The 
amount of heat may vary somewhat, accord- 
ing to individual needs. If a child is fretful 
in a high temperature, or faints, a lower one 
may be carefully tried. When it is found 
that a child thrives in an incubator at a 
temperature of 80 degrees, he may be 
removed from it and kept in a room at about 
that temperature, providing it is properly 
ventilated, and the heat kept even. 

Bed — There is usually a grating provided 
upon which the child is to be laid. This 
grating has an air-space around the edge, 
which must be kept free so as to secure 
proper circulation. The bed may be simply 
a pad of non-absorbent cotton, covered with 
gauze to keep it in shape. It should be 
renewed as often as it becomes lumpy or dis- 
arranged, or if there is a suggestion of odor. 



The Nursing of Children 




HOODED DRESS 
FOR PREMATURE BABY 



DeLee advocates the use of down, on 
account of its heat-retaining quahties. A 
small down sofa pillow can be had for fifty 
cents, and is very satisfactory. 

Clothing — ^Little clothing should be used; 
only enough to keep the baby warm. Cooke 
advises a jacket made of gauze and cotton, 
and some of the best infants' hospitals use 
this. It may have two layers of gauze, or 
only one, leaving the cotton next to the 
child's skin. Holt suggests wrapping the 
baby in cotton, held in place by bandages, 

89 



The Nursing of Children 

but this is not particularly convenient, as it 
quickly becomes disarranged. DeLee de- 
clares that such a practice may cost the 
child's life and that fine wool flannel is the 
rational material. 

A convenient dress is the sleeveless slip 
referred to in Part I, made of the softest 
flannel and fastened closely about the neck. 
These babies lie so quietly that a diaper is 
not necessary; simply a piece of absorbent 
cotton or old linen imder the buttocks may 
be used. A soft flannel binder should pro- 
tect the cord. If the feet are inclined to be 
cold, wool bootees should be used. The 
head should be protected by a turban or cap 
made of gauze and cotton. A light wool 
blanket may be needed for covering, but one 
should be careful about its weight. 

Bathing — Medical authorities agree that 
the regular bath is not wise for the pre- 
mature infant. For the first cleansing the 
infant should be anointed with warm oil or 
albolene. If necessary, a little warm, soapy 
water may be used to remove the vernix 
caseosa, as there is more on the premature 
than the normal infant. After this cleans- 
ing it will not be necessary to give a bath for 

90 



The Nursing of Children 

some time. After an evacuation of the 
bowels the buttocks can be cleansed with 
albolene or vaseline. It may be necessary 
to sponge the face and hands, but it will be 
seen that water causes chafing, irritation and 
even cracking of the skin. A little bicar- 
bonate of soda added to the water may 
relieve the condition. It is better to use no 
water, but simply vaseline, which removes 
the dirt and acts as an emollient. 

A gentle massage should be given each 
day and an oil rub at least every other day. 
Olive oil should not be used for this purpose, 
for even if pure — which is rarely the case — 
it is not readily absorbed by the skin, and its 
use may cause an eruption; benzoinated lard 
or cocoanut oil is far better. 

Handling — The premature infant's physi- 
cal condition demands rest. His daily rub- 
bing and cleansings may be given without 
removal from the incubator. The nurse 
must remember to alter his position every 
few hours to insure comfort. Care should 
be taken to notice that the ear is not folded 
over, as permanent deformity may take 
place. 

Weighing — ^The incubator that has a scale 

91 



The Nursing of Children 

attachment gives the infant that much ad- 
vantage. If not, the child may be removed 
once daily to be weighed, as the gain or loss 
in weight is one of the guide-posts to his care. 
The room should be warm and protected 
from draughts. The scales should be accu- 
rate beyond a doubt and weigh to half 
ounces with accuracy. 

General Care — ^The eyes should be cared 
for as in any yoimg baby. The nose should 
be kept clean by means of a tiny cotton 
applicator. The mouth should be inspected 
several times a day and gently cleansed often 
enough to keep it in good condition. Do 
not use the finger for this cleansing, but a 
large, soft applicator, handling it with great 
care, so as not to break the tender mem- 
brane. 

Note carefully the amount and frequency 
of urination and bowel movements, and see 
that these excretions are promptly removed. 
Keep the parts very clean, especially about 
the urethra, as a bit of dried secretion may 
interfere with urination. 

Nursing — Incubator babies are, as a rule, 
too weak to nurse from the mother's breast. 
The attempt is sometimes made, only to find 

92 



The Nursing of Children 

that when the child appears satisfied he is 
merely exhausted, and has not secured much 
nourishment. If the teterelle can be used, 
so that the quantity of milk taken may be 
seen, it may be well worth while. This is a 
combination of breast pump and feeder; the 
mother, by suction on the top tube, draws 
the milk from her own breast, and then gen- 
tly, drop by drop, feeds it to the baby with- 
out loss of time. 

When to Begin Feeding — The nurse must, 
of course, follow orders in this, but she should 
remind the physician and see that he gives 
her some definite plan to go by. Plenty of 
water should be given from the start. Rotch 
and Holt give nothing but water or a solu- 
tion of milk sugar (for keeping up the bodily 
heat) for thirty-six hours. Cotton advises 
feeding within a few hours after birth, and 
DeLee places great emphasis on early and 
persistent feeding. 

Mode of Feeding — If a small doll's spoon 
can be had, it may be used in feeding, but a 
spoon is never very satisfactory, as it is 
difficult to judge of the amount actually 
taken. A medicine dropper is much better, 
but a slight roughness on its edge may injure 

93 



The Nursing of Children 

the child's mouth and the whole dropper is 
rather sharp. Probably the most satisfac- 
tory feeder is the ^'Breck," which consists of 
a short graduated glass tube, with a rubber 
nipple at the lower end, and a rubber bulb 




BRECK FEEDER 

at the upper. In filling, both nipple and 
bulb are removed, a cork inserted in the 
lower end, the proper amount of milk put in, 
bulb and nipple replaced. The bulb is used 
for injecting the milk into the child's mouth, 
as many of these babies are too weak to 
make the exertion required in the act of 
sucking. Care should be taken in using this 
feeder to have both it and the milk warm, 
as cold milk is hardly the thing for a feeble 
infant. 

Amount of Food — ^The tendency is always 
to overfeed a premature baby. This may 
cause simple regurgitation, but even this is 
dangerous, because particles of curd may 
get into the trachea and cause pneumonia 

94 



The Nursing or Children 

or asphyxiation, or the action of the heart 
may be affected by an overfull stomach. 

Cooke's rule for feeding is to ''give half 
the strength and half the amount, twice as 
often as to a full- term child." 

DeLee goes by the child's weight and his 
tables are very exact. To a child weighing 
less than three poimds he gives 15 drops of 
nourishment every 30 minutes for the first 
day of life, 30 drops every 45 minutes the 
second day, lyi drams every \yi hours the 
seventh day, and so on. For a baby weigh- 
ing about four pounds he begins with one 
dram at 45-minute intervals. 

The nurse's record should show the 
amount actually taken in twenty-four hours. 
A very small baby may not take more than 
two ounces per day at the start, while a 
larger one may take as much as five oimces. 
The quantity may, as a rule, be increased 
rapidly, till it is 4 to 10 ounces at the end of 
the first week. After digestion is well estab- 
lished, the rule is to give an amount equal to 
one-fifth of the child's weight. 

Each baby presents an individual problem 
in the matter of feeding, and the child's con- 
dition and appetite must govern the nurse 

95 



The Nursing of Children 

somewhat. If there is no regurgitation and 
the digestion seems good, the amount may 
be cautiously increased. Very often the 
doctor leaves the entire matter to the nurse, 
but it is her duty to keep him informed of all 
conditions. 

Kind of Food — ^The best authorities con- 
sider breast milk essential in feeding pre- 
mature children. It should be obtained at 
all costs, and since the quantity required is 
so small this should not be difficult. In a 
hospital, two mothers might be asked to 
each furnish a part of the amount. It is not 
necessary that the woman from whom the 
milk is obtained should be recently deliv- 
ered, though it is advisable that her child be 
not more than six weeks old. 

It is best to obtain fresh milk for each 
feeding, but if this cannot be done, it may 
be kept in a bottle on the ice. All utensils, 
breast pump, bottle, etc., used should be 
sterile, the nurse's hands and the woman's 
breast carefully washed. The bottle of milk 
should be shaken each time before using so 
that the cream may be evenly distributed. 

At the beginning, equal parts of breast 
milk and a 4 per cent, solution of milk sugar 

96 



The Nursing of Children 

may be used. Pure breast milk may be 
tried about the fifth day and if well borne 
may be continued. 

As a substitute for mother's milk, whey 
diluted about one-third, with a small 
amount of cream added is excellent. Pre- 
digested .milk combined with barley water, 
is sometimes ordered. Peptogenic milk is 
also used. Most physicians do not try 
the prepared foods. Some physicians 
use a drop or two of brandy with each 
feeding. 

Gavage, Nasal Feeding — Some premature 
infants are so weak and small that they are 
unwilling or imable to swallow. A stomach 
or nasal tube may be used in these cases. 

The tube, a small catheter, should be ster- 
ilized, and a small sterile funnel attached to 
it. (The body of a glass dressing syringe 
may be used, if no small funnel is at hand.) 
One encoimters no difficulty in inserting 
the tube, and there is little danger of its 
going into the trachea. Raise the child's 
head a little and tm'n it slightly to one side. 
Fill the tube with milk and clamp it with the 
fingers while it is being passed. It is best to 
have a mark upon the tube about four inches 

97 



The Nursing or Children 

from the eye, to insure its insertion a proper 
distance. The required amount of milk is 
poured slowly into the funnel, allowed to run 
down, and the tube gently withdrawn. The 
child should be laid carefully back upon his 
bed and allowed to rest for some time after- 
ward. Any regurgitation or symptoms of 
overfeeding should be reported. 

Rectal Feeding — It may be necessary to 
resort to rectal feeding. For this use a 
medicine dropper or the smallest catheter 
obtainable. The nurse will probably find 
the dropper easiest to manipulate, but she 
must exercise the greatest possible care not 
to injure the delicate tissues. The fluid 
should be given very slowly indeed. After 
its administration a piece of cotton should be 
held against the anus for some time to insure 
its retention, but the peristaltic action of the 
intestine is usually feeble, and little difficulty 
is experienced. Alcoholic stimulation may 
be given with rectal nourishment. 

The care of premature children demands 

Constant attention, 

Exactness in detail, 

A gentle touch, 

Minute observation. 

98 



The Nursing of Children 

To the nurse who can give these the 
results are often very definite. She fre- 
quently saves a life, and always gains the 
appreciation of the physician and the family. 
The specialty is one not overcrowded. 



99 



PART VII 

Nursing in Abnormal or 
Diseased Conditions 

THE opinion that the nurse is a kind of 
substitute doctor is common, and the 
nurse should do all she can to abolish this 
idea. If she will impress upon the laity that 
she does not diagnose nor prescribe she will 
save much trouble for herself, her patient 
and the physician. No well-trained nurse 
desires more than her own responsibility in 
a case, and it is seldom that a nurse is called 
on to take the initiative in the care of a 
patient, even though that patient is only a 
baby. The next articles will, therefore, 
deal with the knowledge a nurse needs to 
care for a sick baby intelligently, the nursing 
treatment of the various diseases and spe- 
cial things which she may do in an emer- 
gency. 

Prevention — An ounce of prevention is 
better than a pound of cure in nursing, as in 
other things. A nurse or mother may some- 
times prevent an attack of sickness by 
prompt and intelligent treatment of alarm- 

lOO 



The Nursing of Children 

ing symptoms. As a rule, the health of the 
baby may be maintained by proper feeding, 
attention to the bowels and plenty of fresh air. 
At least one good bowel movement each day 
must be secured and that by the simplest 
possible means — by diet for a steady thing, 
by enema when needed, by laxative or 
cathartic rarely. The trial for a daily evac- 
uation of the bowels should be made at a 
definite time. The child must be suppHed 
with well-cooked, simple food at proper 
intervals. Proper food is as important as 
regularity in feeding. Great variety in food 
is not a thing to be desired for children. 
There are many articles of diet which are 
not to be even thought of in connection with 
little children. Fresh air means out-of-door 
air, \vdnter and summer, and the most of 
every day, imless the elements forbid. The 
child may be put in a sheltered nook. The 
condition of a child who is ner^'ous and a 
poor sleeper \d\\ improve wonderfully under 
the fresh-air treatment. 

It is wise to regard the tendency to disease 
as an abnormal condition. One of the 
newer ideas in connection wdth the care of 
children is to combat the tendency. Dr. 

lOI 



The Nursing of Children 

Pritchard, of London, has written an article 
on ^^The Heat-Regulating Mechanisms of 
Childhood," which is illuminating. His 
favorite subjects are children with a ten- 
dency toward tuberculosis, rickets or mal- 
nutrition. He believes in varied thermal 
stimulation. The first treatments are mild 
and the child is gradually led from a mild to 
a stronger stimulation. This is effected by 
means of air and water. As soon as the 
child's digestion is established and he is 
gaining weight, he may be taken out-of- 
doors properly protected. The first bath 
he considers should be at loo^. His treat- 
ment, as a rule, begins about the fourth or 
fifth week of life. The temperature of the 
baby's bath is to be lowered i° every day, or 
every other day, according to the individual 
case. If the child shows a dislike for the 
cooler bath a higher temperature is resumed. 
Some of the babies do not enjoy a tempera- 
ture lower than 80°. Many of his subjects 
take a bath of from 60° to 70° before they 
are five months old. As a rule these babies 
are distinguished for their clear complexion, 
health and vigor. 
Causes of Disease — A large proportion of 

102 



The Nursing of Children 

the diseases of infants is due to digestive 
difficulties. Most of these disturbances 
may be corrected if the proper attention is 
given at the proper time. If neglected, 
death is the most common result, and here a 
point lost sight of by the laity is that lives 
are saved through intelligent care and not 
through drugs. A nurse should learn that 
while medicine may carry a child through an 
acute condition, it is almost useless in the 
continued treatment. The important things 
are trained watching of symptoms and cor- 
rect care, and the common causes of dis- 
eases are: Impure water, careless feeding 
and overfeeding, improper clothing, im- 
healthy surroundings, lack of cleanUness in 
the preparation of food, and lack of judg- 
ment in its selection. 

Points in Nursing — Methodical and exact 
noting of symptoms are the first essentials in 
the nursing of sick infants. This is the basis 
of all diagnosis and treatment, and it is at 
this point that the value of the trained 
nurse's work is shown. The physician may 
form wrong conclusions from inaccurate or 
incomplete reports, and his patient suffers 
accordingly. Accuracy in the carrying out 

103 



The Nursing of Children 

of orders is the second essential. It is this 
dependabihty which constitutes the chief 
difference between the trained and the 
untrained nurse. Every nurse who under- 
takes the care of a child should realize this 
and know that while her experience may be 
helpful to her, exactness and keen observa- 
tion is even more important. 

Holt's schedule of what to observe is most 
useful to the nurse, since it points out the 
chief factors in the case. It is as follows: 

Weight — Note gain or loss. 

Stools — Character and frequency. 

Vomiting or Regurgitation — When and 
how much. 

Flatulency or Colic, 

Appetite — Is the food given enough or too 
much? 

Is the child comfortable and good-tempered? 

Amount of sleep. 

Weight — A normal child should have firm 
flesh and muscles which are capable of ener- 
getic action. It is possible for a child to 
gain in weight and not be in good condition, 
but it is impossible for a child to steadily 
lose and not be in a serious condition. The 
child's weight is an important item, and 

104 



The Nursing of Children 

during sickness should be noted daily, if 
possible. He should be weighed without 
clothing at the same time each day, prefer- 
ably just before nursing. A graphic picture 
is given if a weight chart, similar to a tem- 
perature chart, is kept. 

Stools — The bowel movements are an 
important factor in determining the condi- 
tion. A record should be made of the num- 
ber in twenty-four hours, and the color, 
consistency and amount noted. It must be 
remembered the color may change after it 
has stood for some time; oxidization may 
occur and what was in color a normal move- 
ment may be in twelve hours a green color. 
The average bowel movement should be 
taken as a standard for the twenty-four 
hours, as the movements may vary in the 
course of the day. 

A normal stool for a young baby is a mass 
of bright yellow particles of the consistency 
of soft cottage cheese; the odor is character- 
istic but not offensive. It should be noted 
if there is pain and straining with the pas- 
sage; if there be green movements or streaks 
of green; if there be fermentation or froth. 
Brown or brownish yellow stools are abnor- 



The Nursing of Children 

mal, as are also white or clay-colored stools. 
There are the green and white stools and in 
some cases there is tenacious mucus. A 
colorless, nearly odorless, fluid movement 
may occur. An offensive odor is always 
abnormal. Neither a liquid nor a formed 
stool is normal. A serious condition may be 
indicated by hard masses or blood. The 
presence of large curds should be reported, 
but small curds may be regarded as normal. 
A normal stool does not cause chafing or 
irritation. 

Vomiting or Regurgitation — Regurgitation 
is the process of throwing a part of the food 
from an overloaded stomach. It is a wise 
provision of nature. Vomiting proper is 
accompanied by nausea and as a rule occurs 
some time after the nursing period; the 
vomited matter will be sour, with, perhaps, 
curds, and indicates a serious condition. 

Regurgitation may also be caused by too 
rapid feeding, handling after food is given, 
hiccough, tight clothing, etc.; attention 
should be paid to all these points. When it 
occurs the character of the material should 
be noted; there may be large or small curds 
or fluid with no curds. The amount, whe- 

io6 



The Nursing of Children 

ther part or all of the food taken, should be 
observed. The time, whether immediately 
after nursing or an hour later, should be 
noticed. The general appearance of the 
child is significant; if he be pale or blue 
about the mouth, or have a cold perspira- 
tion about the head. 

If all known causes for regurgitation be 
removed and it still continues after breast 
feeding, try giving about a half ounce of 
water a few minutes before nursing. If there 
seems to be some definite trouble with the 
digestion, a physician should be consulted. 

Colic — ^The symptoms of flatulency or 
colic are as follows : Distention of the abdo- 
men, rumbUng or gurgling in the intestines, 
escape of flatus from the abdomen or mouth, 
a sudden sharp cry, accompanied by kicking 
or drawing up of legs. A continuous per- 
sistent cry is seldom due to colic. 

So-called colic may be caused by the 
formation of uric acid crystals in the blad- 
der. An abundance of water will relieve 
the condition. Intestinal cohc may or may 
not be a serious symptom. With some 
babies there is no bad after-effect. With 
others, coHc may accompany malnutrition 

107 



The Nursing of Children 

of the worst sort. It is due to a variety of 
causes: The feeding may be too hasty; the 
child may become chilled or cold; there may 
be some indiscretion in the mother's diet; 
the child may be overfed; there may be 
either too much proteid or too much starch 
in his food; the mother may be overworked, 
tired or worried. 

When a nurse has decided colic is present 
she may try the simpler remedies to relieve 
it. A bottle of quite warm water by mouth, 
or turning the baby on his face on a warm 
water bag may be tried. Rubbing the 
child's abdomen gently with the hand lubri- 
cated with warm oil may prove effective. 
An enema of soapy water, or better, of milk 
of asafetida (a teaspoonful to an ounce 
of water) is almost invariably effective. 
Whiskey, brandy, paregoric, gin or tea 
should never be given. One or two drops of 
essence of peppermint, or five or ten drops 
of milk of asafetida may be given in warm 
water by mouth. If the condition persists a 
physician should be consulted. 

Appetite — One may learn much of a 
baby's condition by his appetite or lack of it. 
A nurse should note the difference between 

io8 



The Nursing of Children 

mere sleepiness and lack of appetite; a child 
may form the habit of sleeping at the breast 
and later cry from hunger, which is mistaken 
for colic. Before each feeding the child may 
be thoroughly awakened (even if it be neces- 
sary to bathe his face in cold water) until he 
forms the habit of waking at the proper 
time. Always take the time to feed a bot- 
tle baby. The practice of leaving a baby 
alone with his bottle is wrong, and may 
result in serious injury to the child. Proper 
feeding at the proper time should not be 
neglected, even if other work is not accom- 
pHshed. The best proof that an infant is fed 
the proper amount of food is that he gains 
steadily each week and does not habitually 
regurgitate his food. 

As a rule, the amount of food should be 
in proportion to the child's weight; for exam- 
ple, a child that weighs ten pounds will re- 
quire more food than a child of the same 
age who weighs six pounds. The appetite 
will be influenced by the infant's indi\ddual 
characteristics. If it is ascertained that the 
child is really not hungry at the proper 
times, the fact should be reported to the 

109 



The Nursing of Children 

physician, that he may take steps to im- 
prove the condition. 

A child may have a ravenous appetite and 
not be nourished by the food taken. This is 
especially true in marasmus cases. The 
physician may prescribe less food, or more 
dilute food, and the nurse must explain the 
reason for this to the mother. The amount 
of food needed is the subject of considerable 
discussion among physicians. Systematic 
overfeeding is advocated by Rotch and Holt, 
two of the best authorities in the country. 
Less frequent feeding and smaller amounts 
of food is advocated by well-known physi- 
cians abroad as well as by such prominent 
men at home as Winters, of New York, and 
Brenneman, of Chicago. These latter claim 
that every four hours is often enough to give 
food in the beginning weeks, and that in a 
few months three meals a day are sufficient 
for any child. They tell us the amount of 
fat and proteid usually given should be 
reduced and alkalies and carbohydrates 
increased. 

A series of observations on these points by 
a nurse might be of interest and value. 

Comfort and Temper — From the date of 

no 



The Nursing or Children 

birth a baby shows his disposition and the 
observing nurse soon knows his character- 
istics. These should be taken into consider- 
ation. One should note whether the sick 
baby is good-tempered and seems comfort- 
able, or if he is fretful and disturbed. 
Remember, also, that a child may be listless 
from weakness and poor condition, and a 
quiet baby may be too sick to cry. Two 
things often not noted, position in bed and 
clothing, are so closely allied with temper 
that no one but a trained nurse is competent 
to judge of them. 

Sleep — The amount of sleep of a yoimg 
baby should be noted. A very young infant 
sleeps practically all the time, only waking 
to be fed, bathed and for an occasional \dgor- 
ous cry. Even in his second year he should 
sleep fourteen to sixteen hours a day. Dis- 
turbed sleep may be caused by indigestion, 
or may be due to nervousness, from hand- 
ling, rocking, to lack of fresh air, to cold or 
dampness. It may also be a s}Tnptom of 
actual illness. The important thing is not 
to treat the symptom, but to find and 
remove the cause of disturbed sleep. 

Miscellaneous Notes — The nurse should 

III 



The Nursing of Children 

note the skin, as to color, moisture, and 
whether it is cold and clammy or hot and 
dry. The respiration, whether it is quiet 
and regular, noisy, or in any way peculiar. 
If there is any discharge from eyes, nose and 
ears. The color and condition of the gums, 
palate, tonsils and pharynx are important. 
Also the appearance of the tongue. 

All these things are commonplace, but are 
none the less important. The physician 
looks to the nurse for his ablest assistance, 
and her work is vital. Faithfulness is of 
paramount importance in the care of young 
infants. Vigilance and accuracy here save 
lives which were otherwise lost to the mother 
and the world. 



1X2 



PART VIII 

Diseased Conditions 

THE diseases most common to infancy 
and childhood are (i) the various forms 
of digestive disturbance or affections of the 
intestinal tract; (2) infectious or communi- 
cable diseases. In both classes of disease 
the nursing is all-important, and the trained 
nurse has opportimity for the exercise of her 
utmost skill. 

Constipation — This is one of the ills which 
the mother, nurse and doctor must con- 
stantly combat. Its prevalence is doubtless 
due to the character of modern diet, and diet 
is the best means we have of regulating it. 

For some imaccountable reason, most 
articles of diet which are laxative to a nurs- 
ing mother also render her milk laxative to 
the child. Fruits, especially sweet oranges, 
apples, peaches, plums, grapes and pine- 
apple usually have this effect. Bananas and 
berries are not desirable. Green vegetables 
are also excellent, such as lettuce, spinach, 
celery, tomatoes (if thoroughly ripe), string 
beans and tender green peas. Some of the 

113 



The Nursing of Children 

coarser cereals, if well cooked, and graham 
bread or gems are suggested. A full glass of 
water taken on rising in the morning, either 
hot or cold, is advisable. 

A bottle-fed baby may have oatmeal 
water added to its milk at any age, and the 
result in overcoming constipation is usually 
good. After the first few months fruit juice 
may be given a little while before meals. 
This may also be used for a nursing baby. 
Sweet orange or pineapple juice is usually 
the best. 

A harmless and of times effective remedy 
is half a teaspoonful of olive oil once or twice 
a day. Sometimes molasses or molasses 
taffy will have a similar effect. 

The nurse or mother should have a regu- 
lar time for a trial for a daily evacuation, 
preferably just after breakfast. This should 
be begun when the baby is a few months old, 
and continued. A little seat should be 
arranged so that the child is in a comfortable 
position. 

These simple methods almost always 
relieve constipation, unless there is some 
constitutional obstacle, but they are often 
neglected just because of their simplicity, 

114 



The Nursing of Children 

or because they are too much trouble; yet in 
the end they are far less trouble than caring 
for a baby who is ill through neglect. 

For continued constipation which does 
not yield to diet, try massage of the baby's 
abdomen. Anoint the fingers with ohve oil 
or vaseHne and use only the tips. Begin at 
the right side of the abdomen, working very 
gently upwards and around with a kneading 
or rolling motion, following the direction of 
the colon. Deeper pressure may be used as 
the child becomes accustomed to it, but care 
must be taken not to pinch or hurt. 

Temporary reHef may be had from an 
enema of plain water, salt solution or soap 
suds. Very Httle force should be used in 
giving it, and the temperature should be 
about that of the body. A suppository of 
glycerine or gluten, or even soap, may be 
tried, the gluten being preferable for young 
babies. 

As for the use of drugs, do not give even 
the simplest laxative or cathartic without a 
doctor's order. It is not that there may be 
danger, but that a permanent bad habit may 
be formed. 

Diarrhea — This also is usually caused by 

IIS 



The Nursing of Children 

food. It is most common between the time 
of weaning and the end of the second year, 
and more often occurs in summer. It is 
much more common in bottle-fed babies. 
In the hot months eternal vigilance on the 
part of mother or nurse is the price of pre- 
vention, and often means saving life. Light 
clothing, tepid baths, fresh air, smaller 
amounts of food and plenty of pure water 
constitute the preventive treatment. If the 
baby is breast-fed, weaning should be de- 
ferred till cool weather. If bottle-fed, the 
greatest of care must be used to procure 
clean milk, and see that both it and all 
utensils are kept scrupulously clean and 
sweet. A tendency to diarrhea may be 
overcome by adding to the milk or giving 
before meals a little barley or rice water 
(made by cooking the barley or rice in a 
quantity of water and straining). 

If diarrhea appears, a dose of castor oil 
may be given. This will remove any fer- 
menting or offending material from the 
digestive tract. At least a tablespoonful 
should be given, as there is no danger of an 
overdose, and too small an amount may 
simply cause nausea and prolong the loose- 

ii6 



The Nursing of Children 

ness of the bowels, when a large dose will 
remove the trouble in a few hours. It is not 
necessary to disgtiise the oil when giving it 
to children, as they usually take it without 
difficulty. 

Usually all food should be stopped for a 
half day or longer and only water given. 
The first food given after the attack should 
be albumen water or barley water rather 
than milk or any food containing it. Albu- 
men water is made by stirring (not beating) 
the whites of two eggs in six ounces of water. 
Milk is apt to cause a retiu'n of the trouble. 

An enema of cool water is an excellent 
remedy in diarrhea from whatever cause. 
It may be given with safety by any one. 
Every four or five hours one may give sev- 
eral ounces slowly, letting it be expelled. 
The treatment is especially adapted to older 
children, and may relieve when other 
measures fail. 

If in a case where diarrhea is present there 
is marked prostration, or any other dis- 
turbing constitutional S3anptom, the physi- 
cian must be simimoned at once. 

Dysentery — This is an inflammatory con- 
dition of the large intestine which produces 

117 



The Nursing of Children 

frequent and watery stools streaked with 
blood and mucus. There is considerable 
straining with the passages, and usually 
great prostration. 

The disease is infectious, and for this 
reason the nurse should take much the same 
precautions which she does in typhoid, being 
very particular about the cleanliness of her 
hands, disinfecting all linen, particularly the 
child's napkins which are soiled by bowel 
discharges, etc. The child should be iso- 
lated from other children. In hospitals, it is 
customary to provide special nurses for these 
cases, and not to permit the nurse who feeds 
these children to change their napkins. 

The care must be directed by a physician. 
Complete rest in bed is necessary. Milk in 
any form should be discontinued. Egg 
albumen, barley or rice water, beef juice, 
liquid peptonoids, etc., may be substituted. 
Astringent enemata or irrigation of the colon 
with a large amount of an astringent solu- 
tion may be ordered. A double catheter or 
very small Kemp tube may be used for this, 
or the solution may be given as an ordinary 
enema and the child allowed to expel it, then 
more given, etc. The double tube is to be 

1x8 



The Nursing of Children 

preferred, as it causes less irritation. Nap- 
kins should be changed when at all soiled, as 
chafing occurs very readily. 

Cholera Infantum — This is quite similar to 
other diarrheal troubles, except that it is less 
common and much more severe. It is char- 
acterized by vomiting, stools which are odor- 
less and composed of almost pure serum, in- 
tense restlessness and thirst, high fever with 
cold skin and cold extremities, grayish pal- 
lor, rapid pulse and a state of collapse. 
There may be coma. Death often ensues in 
twenty-four to thirty-six hours. 

The treatment consists of frequent small 
drinks of ice water, salt solution given by 
hypodermoclysis or by the drop method by 
rectum, to supply the loss of fluid. Colonic 
flushings with salt solution or an astringent 
may be ordered. All medicine or stimulant 
should be given by h3rpodermic. Hot packs 
or hot baths, even mustard baths, may be 
ordered for the cold surfaces or extremities. 
The child is not allowed to nurse, and is 
usually in no condition at first to take any 
food. The first food given should be very 
dilute. 

Navel Injection — This is well-nigh an un- 

119 



The Nursing of Children 

pardonable offense, and when it occurs the 
blame usually falls where it belongs, upon 
the nurse. It may be prevented by the use 
of sterile dressings for the cord and a thor- 
ough letting alone. For any redness or 
moisture use powdered boric acid. If the 
redness persists, use pure alcohol twice daily, 
applied on absorbent cotton. 

Mastitis — ^This is an inflammation of the 
mammary or breast gland, which frequently 
occurs during the first or second week of the 
child's life. The trouble is common to both 
sexes, and is the accompaniment of a fluid 
resembling milk which is found in the baby's 
breasts. No attempt should be made to 
press out this fluid, as serious damage may 
be done. Keep the breasts very clean and 
prevent the clothing from pressing upon 
them. If there is an active infection, neces- 
sitating lancing of an abscess, the nurse must 
prepare a sterile bistoury, a small dressing of 
sterile gauze, cotton and a narrow bandage; 
alcohol or a weak antiseptic solution may 
be asked for. 

Stomatitis — ^This is the name given to 
small ulcers which appear as white or gray 
spots in the mucous membrane of the 

I20 



The Nursing of Children 

mouth. They may be due to a catarrhal 
condition; to roughness or lack of care in 
cleansing the child's mouth; to liquids which 
are too hot; or, more frequently, to digestive 
disturbances. The treatment consists in 
keeping the mouth clean vdth boric or borax 
solution (the latter very weak), or in obstin- 
ate cases the doctor may order the spots 
touched with burnt alum, a weak solution of 
silver nitrate, or some other astringent. 
This may be accompKshed by means of a 
small applicator of cotton, used while the 
child is crying. 

Ophthalmia — This is also called conjunc- 
tivitis, since it is an inflammation of the lining 
of the lids and the covering of the eye. It is 
an infection, which may be due to the strep- 
tococcus, or more commonly the gonococcus. 

Whether the infection is a simple one or of 
gonorrheal origin, the utmost precautions 
should be observed. Three rules may be 
laid doT\TL: i. Isolate the child and its be- 
longings. 2. Destroy by burning all dress- 
ings and applications which have been used. 
3. Never let even a drop of solution run 
from one eye into the other, and never use 

121 



The Nursing of Children 

anything for one eye which has touched the 
other. 

The onset of the trouble is rather sudden. 
The conjunctiva is red, and there is swelling 
and more or less discharge. The treatment 
usually ordered is irrigation with some mild 
antiseptic solution, usually boric, and the 
application of ice compresses to control the 
inflammation. 

If the ice compresses are to be of any 
value, they must be changed often enough 
to keep them quite cold. If allowed to 
remain on till they become warm, they are 
worse than useless. In most cases they 
need to be changed every two, or at the 
most, three minutes. Either gauze or ab- 
sorbent cotton may be used for them; they 
should be small and thin. 

For eye irrigations, the nurse should 
ascertain from the doctor exactly how he 
wishes them done. Some doctors advocate 
merely a gentle washing out with solution 
trickled into the eye from a bit of cotton; 
others say that there must be considerable 
force to the stream if the work is to be thor- 
oughly done. In the latter case, use a foun- 
tain bag or an irrigation can and a medicine 

122 



The Nursing of Children 

dropper point, either straight, curved or 
collared, as the doctor prefers. Have the 
solution of the required temperature, spread 
a rubber sheet in your lap, with the end 
dropping into a jar, steadying the baby's 
head between your knees. Turn the child's 
head so that the infected eye is down, and 
hold the head with the palms of the two 
hands. The fingers of the left hand may 
separate the eyehds, while the right hand 
directs the irrigating point. The bag may 
be himg four feet above the baby's head, 
or lower, as the physician desires. 

The niu'se must make sure in irrigating 
that the solution actually reaches the sur- 
faces infected and washes out the pus which 
has collected. If a small quantity of pus be 
allowed to remain in contact with the cornea 
it will produce an ulcer which may cause 
permanent damage. It takes some practice 
to do a thorough and skillful irrigation. The 
eye must be opened very gently, and this 
cannot be done if the baby is crying. Some- 
times a drink of warm water will divert the 
child's attention and enable one to do this 
successfully. Always be careful in opening 

123 



The Nursing of Children 

the eye not to press the fingers into it. Sim- 
ply pull the skin of the eyelids back. 

If drops are ordered put into the eye, the 
nurse must be positive that they are prop- 
erly appUed. The baby's arms may be fas- 
tened with a towel so as not to interfere. 
Sometimes one may succeed by dropping the 
solution in the corner of the closed eye, 
holding the child so that the solution will 
run in when the eye is opened. Care should 
be taken that the point of the dropper does 
not strike the cornea of the opened eye. 

Most ophthalmia cases are gonorrheal in 
origin, and must be isolated. Frequently it 
is necessary to provide two nurses, as in an 
acute case irrigations may need to be done 
every half hour and ice compresses kept on a 
good share of the time. Some doctors are 
now omitting the cold applications, claiming 
that they interfere with the nutrition of the 
cornea. Silver nitrate, which was formerly 
much used for its direct action upon the 
germ, is now being replaced by argyrol or 
protargol. 

No unnecessary furniture or other articles 
should remain in the infected room. The 
baby should lie in a high crib or on a well- 

124 



The Nursing of Children 

padded table. There should be a comfort- 
able chair for the nurse, a convenient place 
for basins and other utensils, and conve- 
niences for hand-scrubbing. It is best for 
the nurse to wear a gown and cap, which she 
removes when she leaves the room. While 
irrigating, she should wear automobile gog- 
gles or large glasses of some sort to protect 
her own eyes from the possibility of spatter- 
ing. An infection gotten in this way is a 
very serious matter. After each handling of 
the baby's eyes the nurse must thoroughly 
scrub and disinfect her hands; also, before 
leaving the room for any purpose. She 
should never put her hands to her own eyes 
or even to her face. 

A baby with ophthalmia is not usually 
allowed to nurse, but the milk is pumped 
from the mother's breasts and fed by means 
of a bottle. The child's general care must 
be given proper thought; its digestion must 
be watched, since proper nutrition is import- 
ant. Routine bathing must be attended to. 
The feeding may be done just before or after 
an irrigation, so that the child may be 
allowed to have a reasonable amount of rest 
between treatments. Usually the nurse who 

I2S 



The Nursing of Children 

cares for the baby is not permitted to care 
for the mother. 

Syphilis — Congenital syphilis is not an 
uncommon condition. Correct care may 
save some of the children thus aflflicted, but 
most of them die early in life. The disease 
may also be acquired by the indiscriminate 
handling and kissing of children. Careful 
feeding and general hygienic treatment are 
the chief factors in success with these cases. 
Mercurials are also given, internally (by 
mouth), by hypodermic, by medicated baths 
and by inunction. If mercurial ointment is 
ordered, observe the usual precautions in its 
use — ^protect the fingers with a rubber glove 
or finger cots, choose a new place on the 
body each day — abdomen, sides of chest, 
inside of the thighs, etc. Be careful that no 
one shall come in contact with any discharge 
or open wound. 

Rachitis, or rickets, is due to lack of fresh 
air, improper food, unhealthy surroundings, 
bad condition of the mother during preg- 
nancy, or an inherited weakness in assimila- 
tion. It is characterized by deformities, by 
sweating, tossing of the head, constipation 
or diarrhea, flabby muscles, curved spine, 

126 



The Nursing of Children 

tendency to pneumonia, etc., even though 
the general nutrition may seem good. 

Diet is of vital importance in effecting a 
cure. Milk should be sterilized or pasteur- 
ized. The carbohydrate food should be 
limited, and the fats increased in quantity; 
cream may be given, or even fried bacon; 
cod liver oil may be prescribed. Sweet fruit 
juices may be given. The child should be 
restrained from walking, and massage sub- 
stituted. The nurse should guard against 
spinal curvature, instructing the mother in 
correct postures for the child, when asleep, 
as well as when awake. The physician may 
apply temporary braces to the curved bones. 
Children with rickets should be kept out-of- 
doors as much as possible, providing only 
that they are properly protected against the 
weather. 

Hernia — This is a rather common occur- 
rence in young children. It is not caused, 
as the laity usually think, by excessive cry- 
ing, but may be due to hard coughing, dis- 
tension from indigestion, or straining from 
constipation. 

The most common form is umbilical 

127 



The Nursing of Children 

hernia. These cases usually yield to treat- 
ment, but take several months for a cure. 
A good truss may be made by a circular pad 
held in place by straps of adhesive plaster 
with a firm binder over the whole. An elas- 
tic band is quite useless. The child should 
sleep with his hips elevated, and special care 
should be taken that he does not become 
constipated. 

Inguinal hernia is managed in much the 
same way, but is more difficult, as the truss 
required to keep it in place is apt to slip on 
a small child. Cotton advises the use of a 
skein of wool passed around the child^s 
waist, fastened at the umbilicus in front, 
passed between the legs and fastened again 
to itself in the back. Circumcision should 
be done for these cases if there is any need 
whatever of it. 

Scorbutus, or scurvy, has been considered 
due to defects in diet, but is now thought to 
be of infectious origin. It occurs in epi- 
demics, and in some of these it is found that 
strict cleanliness of the mouth, secured by 
means of antiseptic washes, cures the disease 
without a change of diet. 

Spongy gums are a feature of the disease 

128 



The Nursing of Children 

and hemorrhages in various tissues and 
organs. In children a fresh milk diet, or if 
the child be old enough, baked potato and 
fresh vegetables, may be given, with sweet 
fruit juices; this Une of diet combined with 
thorough care of the mouth, usually cures 
the trouble. 

Bronchitis and Pneumonia are rather com- 
mon diseases of childhood. They are often 
seen in connection with other troubles, 
chiefly those of infectious origin. There is 
cough, rapid respiration (sometimes 50 or 60 
per minute), high pulse and temperature up 
to 103° F., rarely higher. When the skin is 
blue and the respirations extremely rapid, 
the case is a critical one. Small children 
swallow their sputum, and frequently cause 
digestive disturbance by so doing. 

The child should be kept quiet and all 
exertion prevented. Laxatives or purga- 
tives may be needed. Counter-irritants may 
be used on the chest. Hot baths may be 
ordered to help the elimination. If the tem- 
perature is high, tepid or cool sponge baths 
may be used, but care should be taken to 
keep the extremities warm. Only liquid 
food should be given, preferably something 

129 



The Nursing of Children 

warm. The room should always be well 
ventilated. The best results seem to be had 
of late by treatment with cold, fresh air. 
The patient may be put out-of-doors, or in a 
room with wide-open windows. The treat- 
ment seems heroic, but the death rate is less 
and the percentage of good recoveries is much 
greater than with the old methods of keeping 
the patient warm. 

If there is sweating, chilling and remitting 
temperature, empyema may be suspected. 
If it occurs, the chest abscess may have to be 
opened, in which case the nurse must know 
how to prepare for a minor operation. 

Croup y or acute Laryngitis , is characterized 
by harsh cough and obstructed respiration. 
It may appear suddenly in the night. A 
warm room (about 70"^ F.) and very moist 
air usually relieves the spasm of respiration. . 
The crib may be moved to the kitchen and a 
kettle be kept boiling, with tincture of ben- 
zoin or spirits of camphor added to the 
water. Or, a croup tent may be made by 
tying a heavy cord from the center of the 
head of the bed or crib to the foot, and hang- 
ing a blanket or quilt over it; the steam from 
a tea-kettle may be conducted into this tent 

130 



The Nursing of Children 

by means of a rubber, metal, or even a 
heavy paper tube. In many cases the 
immediate trouble may be relieved by caus- 
ing the child to vomit. This may be 
induced by giving a small dose of syrup of 
ipecac every fifteen to thirty minutes. 
Some sort of a laxative should be given. 

Membranous Croup is diphtheria of the 
larynx, and is a very serious condition. It 
never appears suddenly, however. The doc- 
tor should be summoned promptly, and vig- 
orous measures may be found necessary. 
The croup tent may be used, an emetic 
given, ice appHed to the throat or given by 
mouth. Occasionally intubation must be 
done, which means a slight surgical opera- 
tion and watching afterward to avoid dis- 
placement of the tube; if this accident occurs 
the doctor should be sent for at once. 

If this condition is suspected, the child 
should be isolated, any secretion from the 
throat saved for the physician's inspection. 
Antitoxin is usually given in even suspicious 
cases, and saves compHcations as well as 
lives. There are no real objections to the 
giving of antitoxin, and the nurse should 

131 



The Nursing of Children 

always concur heartily when the physician 
advises it. 

Meningitis may be spinal or cerebro- 
spinal. That is, the covering of the spinal 
cord or of the brain and spinal cord may be 
the seat of an infection. The way in which 
the disease is carried is not known, but it 
sometimes occurs in epidemics. The pa- 
tient should be isolated and all precautions 
taken against the spread of the disease. 
The symptoms are acute. There is intense 
headache, contracted pupils, sensitiveness to 
light and sound, retracted head and back- 
ward curving of the spine, temperature high 
or irregular, vomiting, etc. There may be 
twitching of the limbs, or purpuric spots, or 
very slow pulse. The cry is high and shrill. 
The disease may continue for several weeks, 
or may even recur after a partial recovery. 
Children who recover from it are frequently 
defective in some way. 

Hot baths may be used, or the ice bag, 
according to the symptoms presented. 
Packs or sedatives may be ordered for the 
extreme restlessness. The room should be 
kept quiet and rather dark. The nurse 
should watch for a tendency to bed-sores. If 

132 



The Nursing of Children 

the child cannot swallow, rectal feeding or 
gavage may be employed. Lumbar punc- 
tmre may be done. The modern treatment 
is the giving of serum (Flexnor and Jobling) 
and is considered to have passed beyond the 
experimental stage and to be advisable in all 
cases. 

Typhoid Fever is treated in children much 
as it is in adults. The tendency is to restrict 
the diet less than formerly, allowing a con- 
siderable variety of semi-solid food. To 
reduce the temperature, fan baths or packs 
are usually better borne than sponges. If the 
child chills or becomes blue under any cooling 
process, it should, of course, be discontinued. 
At the Massachusetts Children's Hospital, 
no attempt whatever is made to reduce tem- 
perature, and the diet is restricted very lit- 
tle, yet the results are most excellent. Many 
doctors even permit the child to get up to 
the commode rather than to insist upon the 
use of the bed-pan. 

Infantile Paralysis has been one of the 
most dreaded, because mysterious, diseases. 
It is infectious, but the mode of carrying is 
not certainly known; it is thought to be 
carried by some species of fly, and it is fre- 

133 



The Nursing of Children 

quently epidemic in hot weather and 
checked by cold. It occurs more often in 
children under the age of five, but may 
attack older children, or even adults. It 
may be ushered in by headache, fever, vom- 
iting, exhaustion, etc., or the paralysis of 
one or more limbs may be the first symptom 
to be noticed. Complete or partial dis- 
abiUty of one or more extremities may occur. 
The paralyzed limb usually atrophies, or at 
least stops its growth while the rest of the 
body continues. Death seldom occurs, but 
the trouble may be permanent. 

The child should be isolated. Heat may 
be appUed and simple measures used during 
the acute stage. Massage and electricity 
are employed later, and in some cases siu:- 
gery produces remarkable results. 

The cases are not hopeful imless treatment 
by a speciahst is begim early. In expert 
hands, most of the cases have a chance of 
almost complete recovery. 



134 



PART IX 

Communicable Diseases 

nr^HERE has arisen in the last few years 
■^ a distinct change in the methods of 
caring for contagious, or communicable 
diseases. More is being foimd out about 
the diseases themselves, their modes of 
transmission, etc., and some of the traditions 
and superstitions concerning them are being 
discarded. The systematic use of these 
newer methods began about 1900 at the 
Pasteur Institute in Paris, though Grancher 
had used some of the same methods before 
that time. About four years ago the City 
Hospital, Providence, R. I., introduced them 
into this country. That hospital has been 
the chief exponent of these new and simpler 
methods, and has now had sufficient ex- 
perience with them to draw some conclu- 
sions in regard to the work and its results. 
Its success has been most satisfactory, and 
other hospitals in this coimtry are gradually 
adopting them. The Isolation Hospital, 
Jacksonville, Fla., has two buildings planned 
specially for this new technic and began to 

135 



The Nursing of Children 

use it during the last year. The Children's 
Hospital of Toronto, Canada, is also under- 
taking it in its new building. 

Modern operating room technic has de- 
veloped by simplij&cation and by the elimi- 
nation of non-essentials. The technic of 
the care of communicable diseases has been 
modified along lines almost exactly similar; 
in fact, it amounts to a reversed operating 
room technic, and has been termed ^'aseptic 
nursing." 

I. In operating room work, we consider 
all objects unsterile which have not been 
definitely sterilized. In contagious work, 
we consider all objects clean which have 
not been used by patient or nurse. 2. In 
the operating room we avoid touching un- 
sterile objects when once our hands have 
been sterilized. In contagious work we 
avoid touching clean objects when once we 
have infected our hands. In both classes 
of work we proceed upon the principle that 
practically all infection is by contact. 

There is no doubt that a certain amount 
of infection occurs in other ways than by 
direct contact. Dr. Chapin, in his recent 
book "Sources and Modes of Infection,'' 

136 



The Nursing of Children 

insists that the indirect sources of infection 
have been much exaggerated and that con- 
tact infection has been too Httle emphasized. 
We have, he says, been spending much 
time and trouble over the things which 
count for little, meantime neglecting the 
chief source of trouble. That is, we have 
been guarding against infections which we 
believed to be water-borne, air-borne, 
carried in clothing, etc., when all the time 
the chief focus of infection was the patient 
himself, and the chief means of spreading 
these diseases were his secretions and our 
own hands. 

In the modem contagious hospital, all 
sorts of diseases may be treated in one 
building, except as it may be a matter of 
convenience to classify them. Each ill 
patient is considered a unit and is treated 
separately, usually in a small private room 
or cubicle. For convenience in observation 
one or more walls of the room or cubicle 
may be glass. Convalescents from the 
same disease may be cared for in a ward or 
treated as a whole, but in the acute stage 
each patient is entirely separate. When we 
consider the very real danger from errors 

137 



The Nursing of Children 

in diagnosis, and the fact that a child with 
one disease may at the same time be de- 
veloping another, we can see that isolation 
is imperative until convalescence is well 
estabhshed. 

No attempt is made, in the modern 
hospital, to keep nurses for certain kinds 
of cases, nor are utensils kept separate. 
Rehance is placed almost entirely upon 
technic, upon careful and constant sterili- 
zation of hands and utensils. The nurse 
who is well grounded in operating room 
work learns these methods very readily. 
She has always in mind the infected con- 
dition of her hands and of the utensils and 
materials which she is handling. All secre- 
tions and excretions and their containers 
are treated as infected. Bedpans, basins, 
etc., are boiled or thoroughly disinfected 
after each using. Slop sinks and hoppers 
must have faucets which can be turned on 
and off by the foot, knee, or elbow, so that 
the nurse need not touch anything while 
emptying utensils. For the same reason, all 
doors are left open or shghtly ajar, or are 
provided with a lever handle which may be 
operated by the elbow or upper arm. 

138 



The Nursing of Children 

Dishes are used in common; when returned 
from the patients, they are not set down at 
all, but placed directly in the sterilizer and 
boiled. The serving kitchen and its con- 
tents is therefore considered clean. Broken 
food from patients may be dropped into 
paper bags and burned. 

Air-borne infection is counted non-exis- 
tent. The patient's room is considered to 
be infected in varying degrees. Every- 
thing which he has touched or which has 
been used in his care is considered highly 
infected. The head of the bed, the pillows, 
top portion of the sheets, etc., are the most 
infected portions of the rooms. The floor, 
because it is the common receptacle, is 
coimted infected. The walls, except very 
near the patient, the ceiKng, and the win- 
dows are thought to be comparatively clean. 
If a nurse enters the room simply to ascer- 
tain what is needed, to bring something, 
or to do something which does not necessi- 
tate handling the patient nor his utensils, 
she does not put on a gown nor cleanse her 
hands after it. 

If however, she enters the room for actual 
work with the patient, she puts on a gown 

139 



The Nursing of Children 

which hangs just inside the door. The 
inside of this gown is considered clean, and 
the outside, because it touches patient, 
bedding, utensils and nurse's hands, in- 
fected. (Note in this an exact reversal of 
operating room work.) At the City Hospi- 
tal, Providence, the nurse's hair is not 
covered, since she never allows her head to 
touch a patient. For the same reason, her 
shoes are not considered to be infected. 
Her hands and the front of her gown are 
considered the most unclean. After any 
service which necessitates her touching 
patient or utensils, she scrubs her hands 
thoroughly with soap and water, removes 
her gown, then scrubs again before she 
leaves the room. The brush is kept in a 
disinfecting solution, but none is used for 
the hands except in cases of measles or 
chicken-pox. Running water is supplied in 
each room through a "combination" faucet, 
which gives tempered water, controlled by 
an elbow valve, this having been found 
more satisfactory than one with a foot or 
knee action. 

As a concession to public opinion more 
than for any real reason, the nxirses change 

140 



The Nursing of Children 

their uniforms before going to meals or off 
duty, keeping the two dresses in separate 
lockers. Practically, only the hands are 
infected, imless something imusual has oc- 
curred, and if they have been properly 
cleansed, she may go anywhere without 
further preparation. If one keeps in mind 
the technic of the operating room, it is per- 
fectly easy to understand how these simple 
precautions, rigidly carried out, are suffi- 
cient. 

A set of simple rules has been formulated 
at the Providence Hospital which gives the 
important points of this sort of technic. 

TO AVOID TAKING AND CARRYING IKFECTION 

Keep fingers, pencils, pins, labels and every- 
thing out of the mouth. 

Keep and use your own drinking glass. 

Do not kiss a patient. 

Wash hands often and always before eating. 

Keep out-of-doors as much as possible and 
always sleep with window open. 

Do not touch face or head after handling a 
patient before hands are washed. 

Do not allow patient to cough or sneeze in 
your face. 

Do not allow patient to touch your face. 

Do not eat anything that a patient may wish 
to give you. 

141 



The Nursing or Children 

If taking a drink or lunch, be sure to use the 
nurses' dishes. 

Put on gown or change uniform when going 
into ward. 

On leaving ward always wash hands. 

Always remember that infectious diseases are 
taken and carried by contact and not by air 
infection. 

Like operating room work, this technic 
must be practised until it becomes a habit 
before anyone can be sure that she will not 
make a break. In hospitals, any nurse 
who is heedless or habitually careless is 
dismissed as unsafe. 

At the Pasteur Institute, where this 
technic was jirst worked out, the cross in- 
fections occurring in five years time, with 
five thousand cases, did not attain a total 
of two in one thousand, or two-tenths of 
one per cent. At Providence, the propor- 
tion has been higher, but is considered 
largely due to faulty diagnosis. In all 
hospitals which use the aseptic nursing, 
cross infections are uncommon, while in 
those which use the older methods, they are 
all too common. In the recent investiga- 
tion of some of the public institutions of 
New York City we find excellent examples 

142 



The Nursing of Children 

of what ordinary care and precaution does 
not do. 

In private nursing, the nurse rarely sees 
a contagious case until the disease is well 
under way. Sometimes her duty is practi- 
cally nothing but the maintenance of quar- 
antine and watching for complications. 

If she is asked to help decide upon the 
room to be used as a sick-room in a private 
house, she should consider that the time it 
is occupied may be six weeks at least, and 
endeavor to secure not only a sunny, well- 
ventilated room for her patient, but one 
which vnR disarrange as little as possible 
the routine of the rest of the family. It 
should be near the bath room, and have 
running water available if possible. 

All hangings, rugs, and every article 
which can be dispensed mth should be re- 
moved from the room. One or two wash 
basins, brushes for the hands, and antiseptic 
solution should be pro\'ided. Gowtls should 
be had for the doctor and for parents or 
relatives who are to be allowed to enter the 
room. It should be impressed upon par- 
ents that for the sake of other children in 
the family it is best that they do not touch 

143 



The Nursing of Children 

the patient while in the room. If this rule 
must be broken, thorough disinfection by- 
scrubbing must be enforced. 

Dry sweeping should not be done, but 
tea-leaves, bits of dampened newspaper, or 
a damp cloth over a broom should be used. 
The patient's dishes and utensils should not 
leave the room unless they can be boiled 
before anyone but the nurse touches them. 
Food may be brought to the door of the 
room and transferred to dishes held in the 
nurse's hands. Broken food and waste may 
be deposited by the nurse upon a news- 
paper or in a paper bag just outside the 
door of the sick-room; this may be burned 
by anyone who is careful to handle only the 
outside of the package. The water in which 
the patient's dishes are washed should be 
thrown into the water-closet bowl in the 
bath-room, care being taken not to slop it 
nor to touch anything in the room. If 
water from hand-washing must be disposed 
of in the same way, one should be sure that 
the container does not come into contact 
with anything. 

The nurse should keep her street costiime 
in another room. It is usually most con- 

144 



The Nursing or Children 

venient for her to wear an ordinaty uniform, 
leaving it just inside the patient's room 
when she goes out. She should remain in 
the room while on duty and have supplies 
brought to the door for her. It is usually 
more convenient for her meals to be sent 
up to her. It is probably wiser if she wears 
a cap which entirely covers her hair. 

She must never forget her technic, es- 
pecially the washing of her hands after 
any service for the patient and before eat- 
ing. She should get out-of-doors for a while 
each day and remain in the fresh air as long 
as she can. Since most of the communica- 
ble diseases are spread by the nasal and 
throat secretions, most doctors advocate 
the use of a gargle or throat spray by the 
nurse as a precaution. Some of the more 
advanced thinkers beheve however that all 
such practices produce more or less irrita- 
tion which aflfords a soil for the development 
of germs and thus defeats its o^tl object. 

Mumps, or parotitis, is an inflammation 
of the salivary glands. The period of in- 
cubation is two or three weeks. It occurs 
in epidemics most frequently in cold weather. 
It is characterized by pain in the parotid 

145 



The Nursing of Children 

gland, swelling and in the severer cases by 
fever, chilling, or pain in the joints. The 
temperature may go to 104®. There is a 
peculiar sensitiveness to acid articles of 
food. The diet must usually be soft on 
account of the swelling and because of the 
temperature. The duration of the disease 
is five to ten days. 

Measles is an eruptive disease which is 
highly contagious. The mode of trans- 
mission is unknown. A second attack may 
occiir. The period of incubation is ten to 
fourteen days. The eruption appears about 
the fourth day. Desquamation may take 
place in about two weeks. There are symp- 
toms like a severe cold, and the temperature 
may rise to 105^. The child may be fretful 
or drowsy. The eyes are sensitive to light 
and should be shielded. The diet should 
be largely liquid, with plenty of milk. Com- 
plications of the eye, ear, pharynx and 
glands may occur. Inflamed glands some- 
times become the seat of future tubercular 
trouble. The skin should be anointed with 
oil or vaseline. Baths may be given to 
reduce the temperature. 

Chicken-pox, or varicella, is an eruptive, 

146 



The Nursing of Children 

infectious disease, the eruption appearing 
on the first day of the disease. The period 
of incubation is ten to fifteen days. The 
rash appears first upon the face and scalp 
and spreads later to the rest of the body. 
Smallpox may be mistaken for chicken-pox 
There may be fever, chilling, or nausea. 
There is usually considerable itching, which 
may be reheved by the use of oil or vase- 
line. The acute stage of the disease com- 
monly lasts but a few days. 

Whooping-cough, or pertussis, is most 
common in children under ten years of age, 
less common in babies, and may occur in 
adults. The period of incubation is about 
ten days. The mode of transmission is not 
certain, but is probably through the throat 
secretions. There is an inflammation of 
the larynx, trachea and larger bronchial 
tubes. 

The first stage of the disease is catarrhal 
and lasts about ten days. The second stage 
is that of the paroxysms of coughing. This 
is marked by a series of short coughs 
followed by one or more whoops; mucus is 
expelled and frequently the contents of the 
stomach are vomited. The hard paroxysms 

147 



The Nursing of Children 

leave the child in an exhausted state and 
the loss of food by vomiting lowers the 
vitality. This stage lasts two weeks or 
longer. The stage of decline of the disease 
marks a gradual return to health. 

The nursing treatment includes arranging 
for plenty of fresh air for the patient, and 
for frequent feedings of small quantities of 
nourishing food. Food is more likely to be 
retained if given after a coughing spell. 
Medicated inhalations are sometimes order- 
ed to relieve the paroxysms. 

Diphtheria is more common in children 
under ten years of age than in those older. 
Adenoids, enlarged tonsils and catarrhal 
conditions are things which favor contrac- 
tion of the disease. It is an inflammatory 
infection of the mucous membrane of the 
nose, throat or larynx, caused by a specific 
bacillus. The germ may be carried in milk, 
almost never in water, but is usually ac- 
quired by direct contact with a person 
affected. There are, however, many ap- 
parently healthy persons who are " carriers'' 
of this disease, who have the bacillus in 
their mouths or throats in considerable 
numbers and yet show no symptoms of the 

148 



The Nursing of Children 

trouble. The period of incubation is about 
a week. One attack renders a patient more 
liable to a second. 

The membrane of the throat or diseased 
surface is thickened and white, later be- 
coming gray. The breath is fetid; there is 
fever, but not ordinarily very high. In 
severe cases there may be extreme restless- 
ness or marked apathy. Delirious patients 
should be restrained lest they overtax the 
heart. The pulse is often rapid and weak 
and heart complications should be watched 
for throughout the disease. There may be 
albimaen in the urine and nephritis may be a 
sequel of the disease. 

The one curative treatment is the use of 
antitoxin. There should be no question 
raised as to the propriety of giving it. An 
eruption sometimes follows its use, but it is 
not of consequence. Gargles, sprays, swab- 
bings, and irrigation of the nose are com- 
monly ordered as a matter of cleanliness 
and control of extension of the disease. 
Small ice bags may be used at each side of 
the throat, or an ice collar. The diet 
should be liqviid, and nourishment should 
be given at least every two hours. In the 

149 



The Nursing of Children 

laryngeal cases, the croup tent or calomel 
fumes may be employed. Paralysis of the 
soft palate may occur, being recognized by 
regurgitation of food through the nose; 
the physician should of course be promptly 
informed of such an occurrence. Persistent 
bleeding from the nose may occur, even so 
severe as to make it necessary to pack the 
nostrils. In these cases the patient needs 
careful watching so that he does not start 
the trouble a second time. 

The nurse who has charge of a diphtheria 
case is usually given one or more doses of 
antitoxin as a preventive measure. She 
should not hesitate to take this if her 
physician advises it, but if her technic is 
perfect, there should be no need of it. She 
should avoid danger from the so-called 
"droplet" infection, specks of nasal or 
throat secretion thrown off during coughing, 
etc. This is a very real danger. 

Scarlet Fever is characterized by a rash or 
blush which appears first on the chest and 
spreads to the rest of the body, also by 
throat and nose symptoms much like a 
common cold. The rash fades in about a 
week, and desquamation begins, lasting two 

ISO 



The Nursing of Children 

to six weeks or even longer. There is fever, 
its height indicating the severity of the 
disease. There may be nausea, vomiting, 
in severe cases prostration and stupor, or 
delirium or convulsions. 

The incubation period is short, one to 
three days. Infection usually occurs di- 
rectly by contact with a person having the 
disease, or with nasal or throat discharges. 
Some epidemics are thought to have been 
due to infected milk. There is some reason 
to believe that the urine or feces may be 
sources of infection. The idea that the 
disease was transmitted by means of cloth- 
ing or that the flakes of skin from the des- 
quamation were a source of the disease has 
now been abandoned. Children are allow- 
ed to mingle with other children while they 
are still "peeling" provided all other symp- 
toms have subsided, and no cases are traced 
to this practice. 

Complications are common and the nurse 
should have these very much in mind. 
Mild cases are as liable to serious compli- 
cations as are the more severe ones, and 
should be carefully observed for a period of 
at least six weeks. The sudden disappear- 

151 



The Nursing of Children 

ance of the rash may be indicative of heart 
or lung difficulties. Any irregularity in 
pulse should be detected promptly, and any 
muscular rigidity or spinal symptoms. Any 
indication of bronchitis or pneumonia should 
be noted and reported. The slightest pain 
in the ear or mastoid region, any discharge 
from the ear, or the least dulness in hearing 
should be considered a matter of moment. 

The nursing treatment is not unlike that 
of measles. Baths may be given for the 
reduction of high temperature, or an ice 
bag over the heart may be used. The diet 
should be liquid, usually including a certain 
amount of milk Meat broths are usually 
forbidden, and should not be given unless 
by special order. The child should be 
guarded from overexertion, as the heart is 
commonly involved. 

One of the gravest dangers is from the 
development of nephritis. This is a very 
common complication, even in light cases. 
The physician will usually require a daily 
specimen of urine, or the nurse may be 
asked to test for albumen by the heat-and- 
nitric-acid test. 

Desquamation maybe troublesome. Dur- 

152 



The Nursing of Children 

ing this stage, the skin may be well anointed 
with vaseline, albolene or olive oil. 

The Close of a Contagiotis Case. When 
the patient is pronounced by the doctor 
ready to be dismissed from quarantine, 
he should be given a tub bath with soap and 
water, and a thorough shampoo. A dis- 
infecting liquid soap is best for this. After 
the bath, he should step into a clean room 
and dress in fresh clean clothing which has 
not been in the sick-room. 

The tub in which the patient had his 
bath should be well scrubbed and may be 
washed with a disinfecting solution. All 
linen, towels, and clothing which is in his 
room should be boiled or well soaked in a 
disinfectant. All utensils which can possi- 
bly be boiled should be, also any toys or 
articles which the patient has handled. 
The bedstead should be scrubbed with soap 
and water, also the walls and windows. 
The furniture may be wiped with a damp 
cloth. Remember that probably there is 
no real infection of the furniture except the 
bed and the bedside table, if one has been 
used. 

If the physician advises it, or the family 

153 



The Nursing of Children 

wish it, a fumigation may be done, though 
the best authorities consider it useless. In 
any event, the nurse should do her cleaning 
as carefully as if there were to be no fimii- 
gation. The easiest and probably the best 
method of fumigation is the so-called 
''sheet" method with formaldehyde. Bed- 
ding which cannot be washed should be 
spread out loosely over chairs, the mattress 
placed so that the vapor can get at all sides 
of it, dresser drawers opened, etc. A sheet 
saturated with liquid formahn, a pint to 
each looo cubic feet of air space in the 
room, should be hung on an improvised 
line in the middle of the room, and the doors 
and windows being tightly closed, left for 
twelve hours or thereabout. 

After fumigation, or in any case, the room 
should be well aired and simned. The 
mattress and pillows shoxild be put out of 
doors in the sim and air and turned fre- 
quently. Any toys or other articles which 
cannot be properly cleansed are best 
burned. 

After the nurse has finished the cleaning 
up of the room — and it should be remem- 
bered that this is her work — she should 

154 



The Nursing of Children 

take a thorough bath and shampoo and 
dress herself in entirely fresh clothing. It 
is wise for her not to take surgical or mater- 
nity cases soon after nursing a contagious 
case, but she may go to other medical cases 
if she has given herself a proper cleansing. 



iSS 



PART X 

Other Diseased Conditions 

OKIN DISEASES are quite common 
^ among infants and young children, due 
probably to the fact that their skins are deli- 
cate and easily irritated, any irritation 
affording a soil for the development of dis- 
ease. For example, a strong soap may cause 
an irritation of the skin and the irritation 
develop into some chronic trouble. The 
groins, the creases under the arms and 
the folds behind the ears should receive par- 
ticular attention. Unclean or damp diapers 
cause chafing and sometimes soreness, which 
if neglected may become true eczema. In- 
digestion and acid urine may irritate the 
buttocks or vulva; plenty of water to drink, 
regulation of the digestion and attention to 
the local condition are then necessary. 

The heads of infants frequently present a 
yellowish crust, which is doubtless due to 
lack of cleanliness; this should be well 
anointed with olive oil or albolene, allowed 
to remain for some time, and the crust care- 
fully and thoroughly removed. When the 

iS6 



The Nursing or Children 

child goes to school, he may acquire pediculi 
from other children, causing a diseased con- 
dition of the skin. The remedy for pediculi 
is tincture of larkspur gently rubbed into 
the hair, as one uses a hair tonic, the head 
being wrapped in a towel for some hours or 
over night. This treatment does not kill the 
nits, and a second or third appUcation will 
probably be necessary, but it is cleaner and 
easier to apply than kerosene or other 
remedies. 

Some foods are thought to cause eruptive 
diseases, and there are children, as there are 
grown persons, especially susceptible to these 
irritations. 

Scabies, the itch, is due to a small parasitic 
animal which burrows in the skin. The con- 
dition is highly contagious. The cure for it 
is sulphur ointment, which is effective after a 
few applications. 

Urticaria, nettle rash, is due directly to 
indigestion or some especially irritating arti- 
cle of diet. Strawberries, fish, pork, etc., 
are said to cause it. The chief treatment is 
the removal of the offending substance from 
the alimentary tract by the use of a laxative. 
To relieve the intense itching, dilute ammo- 

157 



The Nursing of Children 

nia or vinegar may be used, or a solution of 
baking soda. 

Eczema in young children is an accom- 
paniment of digestive disturbances, and can- 
not be satisfactorily treated except by a 
physician who will regulate the child's diet 
most carefully. A diet containing too high 
a percentage of fats, starches and proteids is 
said to favor the development of the disease. 

In addition to the regulation of diet, some 
external application will be necessary, usu- 
ally ointment of some sort. This must be 
used generously and will have to be kept on 
by some sort of a bandage. If the eruption 
is on the head, a cotton cap or bonnet may 
be used; if on the face, a mask with holes for 
eyes, nose and mouth may be sewed into 
the bonnet. The extremities are easily ban- 
daged with a roller of gauze. If the erup- 
tion is on the body, old shirts may be used 
over the ointment, and they should not be 
laundered, only aired. No bathing should 
be done, except the little which is absolutely 
necessary for cleanliness, as water only 
aggravates the trouble. If soap is needed, 
tar soap is best. 

The child should be kept from scratching 

158 



The Nursing of Children 

the affected parts or healing cannot take 
place. This is difficult, and may even seem 
cruel, but the rapid healing which takes 
place when the surfaces are let alone very 
quickly justifies any restraint which may be 
necessary. With babies, the hands may be 
pinned into the sleeves and the sleeves fas- 
tened away from the face by pinning them 
with large safety pins put through the dress 
into the diaper. Splints of pasteboard or 
celluloid, padded and put around the elbow 
are also used. Older children may have the 
hands fastened behind them with soft ban- 
dages, great care being exercised not to get 
them too tight. At the Infants' Hospital, 
Boston, a long tube of soft muslin is used, 
the baby's hands put one in each end, the 
end pinned to each sleeve, thus covering the 
hand completely. The central portion of 
the restraint is then fastened loosely to the 
side of the crib. By this method the child 
gets proper muscular exercise, yet the hands 
are kept away from the face. 

SURGICAL CASES 

Much surgery is now done among children 
and the results are ordinarily good. The 

159 



The Nursing of Children 

care after operation is not essentially differ- 
ent from that accorded adults, except as the 
cases themselves differ. Children usually 
make rapid recoveries from operation, 
partly, it may be, because they are better 
patients than adults. 

Adenoids are fimgous growths found in the 
back of the nose. They interfere with 
breathing, render the mucous membrane 
susceptible to disease and provide a lodging 
place for germs of all sorts. Adenoids are 
sometimes the cause of digestive disturb- 
ances, and cases of mental and even moral 
deficiency have been traced directly to them. 
If not removed, they frequently atrophy and 
disappear by about the twelfth year, so that 
very few adults are troubled with them. 
Meantime, however, they have done much 
direct damage to the child's general health, 
made him an easy victim to contagious dis- 
eases, and laid the foundation for permanent 
ailments. For these reasons, they should be 
removed as early as discovered. If the 
operation is not thoroughly done, it may 
fail of its effect or even seem to stimulate the 
adenoid growth and will have to be re- 

i6o 



The Nursing of Children 

peated. In an occasional case, they recur 
even after the most radical removal. 

There is no preparation for the operation, 
except to see that no solid food is taken for 
a few hours before. Both anesthetic and 
operation are short and recovery is rapid. 
The child may be kept in bed the day of the 
operation, but is allowed to be up the second 
day, and usually does not complain after 
that. Liquid food is allowed the first day, 
or even a full meal after twelve hours. 

Very often a quantity of blood is swal- 
lowed during the operation and vomited 
afterward. If the pulse becomes weak or 
the child has a marked pallor, the physician 
should be simimoned at once, as a continu- 
ous hemorrhage may be taking place. The 
operation is usually considered to be with- 
out danger, but in occasional cases a fatal 
hemorrhage has taken place. 

Tonsillotomy — Diseased tonsils afford good 
soil for pathogenic germs and an entrance 
to the body for many diseases. They may 
be the seat of an infection which results in 
rheumatism and ends with heart complica- 
tions. Enlarged tonsils, which usually 
means diseased tonsils, are quite common. 

i6i 



The Nursing of Children 

If the case is an aggravated one, and some 
general infection has occurred, it may take 
a long time to get a child into condition to 
take an anesthetic and have them removed. 

There is practically no preparation for the 
operation. It is well to be assured that the 
bowels have moved well within the last 
twelve hours, and that no solid food has 
been taken for a few hours previous. The 
operation, like that for adenoids, is a bloody 
one, and considerable blood is apt to be 
swallowed. The child must be watched 
carefully for some hours after operation, as 
serious or even fatal hemorrhages have oc- 
curred. In most instances recovery is rapid 
and the child may be up within the day. 
The appearance of any bright red blood, or 
any weakness in pulse, or marked pallor, 
should be taken as danger signals. Food 
should be liquid or semi-solid for a day or 
two, and preferably cold. Milk, ice cream, 
etc., are usually acceptable. If there is 
difficulty in swallowing, the physician 
should be notified. Solid food may be given 
upon the doctor's order. 

Harelip and Cleft Palate — Plastic opera- 
tions for the remedying of these defects are 

162 



The Nursing of Children 

frequently done and in the hands of a spe- 
cialist produce excellent results. It is rare 
that a combination of the two defects can be 
remedied in one operation, and even a third 
may have to be done. It is usually advised 
that operation be imdertaken during the 
first few months of life, though it may be 
delayed if there is reason for so doing. 

Food should be withheld for four hours 
before operation, if possible, though water 
may be given wdth the consent of the sur- 
geon. The child's face should be thor- 
oughly washed, and the inside of the mouth 
and nose cleansed with soft cotton sponges 
and an antiseptic spray used. An older 
child should have the teeth well brushed and 
the nose sprayed. Surgical cleanUness is 
not, of course, possible, but ordinary clean- 
liness should be secured. 

After the operation, great care must be 
taken not to pull out the stitches nor allow 
them to become loosened. Those inside the 
mouth are most difficult to watch. Food 
should be given neither very hot nor very 
cold. It should be given by means of a 
spoon or medicine dropper, not from a bot- 
tle. It is possible in some cases to feed a 

163 



The Nursing of Children 

baby from a bottle properly held (with the 
baby lying on its face), but it is not advis- 
able to run the risk. The surgeon will usu- 
ally state just how he wishes the feeding 
done and what the food is to be. Obviously 
only soft or liquid food should be given 
until the edges begin to unite. The mouth 
must be kept clean as best it may, and the 
procedure must be done by sight, so that the 
stitches shall not be disturbed. For the ex- 
ternal stitches, some surgeons use a dressing, 
some leave the wound entirely uncovered. 
In either case, care must be exercised in 
washing the child's face, that one does not 
pull the skin of the lip and so cause separa- 
tion. The face should be rubbed toward the 
nose, never away from it. 

Eye Operations need practically no prepar- 
ation. The face should be washed, especial 
attention being given to the part around the 
eyes. If the surgeon so orders, the eye may 
be gently washed out with boric solution at 
blood heat. Some surgeons may order a 
compress wet with boric solution placed over 
the eye and fastened on with a roller ban- 
dage. 

Eye cases require little after attention, 

164 



The Nursing of Children 

either from nurse or surgeon. If the eyes 
are bandaged, the child must be amused or 
kept busy at something. 

Mastoiditis is an inflammatory condition 
of the cells of the mastoid bone, just behind 
the ear. It is usually connected with mid- 
dle ear trouble (otitis media), and is a dan- 
gerous condition. It may terminate in per- 
manent loss of hearing, or the infection may 
burrow inward to the brain, resulting in 
meningitis. For this reason, any complaint 
of pain in the ear or the region just back of 
it should be given strict attention. 

Mastoiditis may be treated with hot 
fomentations, irrigation of the ear with boric 
solution as hot as can be borne (using a foun- 
tain bag hung very low), or leeches may be 
appHed. In some instances Nature responds 
to this sort of treatment and takes care of 
the infection, but in many instances an 
apparent cure is followed later by a severe 
attack. If the case is true mastoiditis, 
operation is usually necessary in the end, 
and must be done by a speciaUst. 

Before operation, the child is fed carefully 
as for any case where an anesthetic is to be 
given. The hair must be shaved for some 

i6s 



The Nursing of Children 

distance back of and above the ear, and the 
surrounding parts well scrubbed with soap 
and water. If the part is so sensitive that 
this cannot be properly done, it may be post- 
poned until the child is under the anesthetic. 
The ear should also be cleansed, the folds 
well scrubbed and the canal irrigated. 

After operation there is usually great 
relief. Any return of pain should be at 
once reported, as it is a serious symptom. 
For dressing these cases there will be needed 
small scissors, slender forceps, a small probe, 
a small glass syringe, very narrow packing 
(iodoform or plain), and a kidney-shaped 
basin. 

Talipes, or clubfoot, can nowadays be 
corrected very satisfactorily, often without 
operation, if the case is taken care of early. 
The nurse who comes into contact with a 
case of the sort should do all in her power to 
have a specialist seen without delay and 
treatment promptly begun. She should also 
impress upon the parents the importance of 
carrying out faithfully and persistently the 
after treatment, since much depends upon 
this. These cases are apt to be long, but the 
results are most satisfactory. 

i66 



The Nursing of Children 

In cases which are corrected without oper- 
ation, the feet are strapped with adhesive 
and bandaged, or plaster casts are put on. 
If an operation is done, the dislocated bones 
are wrenched into place, and sometimes it is 
found necessary to cut some of the tendons. 
After either operation or manipulation, there 
is a good deal of pain, so that an anodyne 
may have to be given. If the child is 
unable to sleep at night on accoimt of pain, 
the physician should be informed. Children 
bear pain much better than adults and usu- 
ally sleep in spite of it. The nurse may 
know, therefore, that when a child is wake- 
ful from pain or cannot be amused be- 
cause of it, it is very intense and demands 
relief. 

A child who has been operated for talipes 
must usually be off his feet for some time, 
and must frequently wear braces for months. 
It is very necessary that these braces be 
properly adjusted and worn as ordered, if 
good results are to be obtained. 

For a dressing following a clubfoot opera- 
tion, there will be needed sheet cotton, gauze 
bandages, plaster bandages of the proper 
width, a knife for cutting the cast, vinegar 

167 



The Nursing of Children 

or other means of softening the plaster; 
in short, whatever the surgeon is accustomed 
to use in taking off and putting on a plaster 
cast. 

Abdominal Operations — ^The most com- 
mon abdominal trouble in children which 
necessitates surgery is appendicitis. Intes- 
tinal obstruction may also necessitate an 
abdominal operation. 

The usual symptoms of appendicitis in 
children are: Rigidity of the abdominal mus- 
cles, abdominal pain and tenderness, normal 
or low temperature, rapid, thready pulse; 
there may be vomiting and thirst. The 
child usually lies on his back with the right 
leg drawn up. 

If the case is treated without operation, 
the child must be kept in bed and no food 
given. Water may be given freely if there is 
not too much vomiting. Hot applications 
may be ordered to the abdomen, or an ice 
bag. Strict obedience to orders must be 
enforced, and parents should be informed 
that any transgression may cost a life. 

The only curative treatment known for 
appendicitis is operation. The technic is 
the same in children as in adults. In serious 

i68 



The Nursing of Children 

cases careful watching is needed for the first 
day or two, but ordinarily recovery is very 
rapid. If an abscess is found and drainage 
must be used, the outside dressings may 
need frequent changing and the case will be 
a tedious one; but the child is usually 
allowed to be up in a short time, as if there 
were no drainage. 

Cases of intestinal obstruction which 
require operation are always serious, as they 
must be done with the patient in poor condi- 
tion. Recovery is usually rapid, however. 



169 



PART XI 

Nervous Conditions and Diseases 
of the Nervous System 

CHILDREN have a very delicately bal- 
anced nervous system, a fact all too 
little regarded by parents, teachers and 
nurses. Seemingly small causes may pro- 
duce grave results, and these results vary 
all the way from simple nervousness to the 
most critical nervous diseases. Heredity is 
doubtless responsible for a good deal in these 
troubles, but environment is after all the 
more powerful in the majority of cases. 

If a child is nervous, in the popular sense 
of the term, it is important to find out the 
cause. This is unquestionably the physi- 
cian's province, but he must be assisted in it 
largely by the nurse. 

Some nervous conditions are inherited; 
this inheritance may be the result of bad 
physical or mental habits or lack of self- 
control along any line. Inherited or ac- 
quired syphilis often has a degenerative 
effect upon the child's nervous system. 

A diseased condition of the eyes will pro- 

170 



The Nursing or Children 

duce nervousness in a child. Or the trouble 
may be a sequence of earlier diseases, fevers, 
contagious diseases, nephritis, rheumatism 
or early malnutrition, or even overexposure 
to extremes of heat or cold. A child who is 
in school may break down nervously from 
the forcing system employed at school, or 
from worry for fear he may not ^^pass." 

A child bom with perfectly steady nerves 
may become a nervous wreck simply by 
living with persons who lack self-control. 
Or the foundation of the trouble may lie in 
the child's treatment during the first few 
weeks or months of Ufe. Unnecessary hand- 
ling, rocking, '^showing off" or much talking 
to may, any or all, be responsible for the 
development of nerv^ousness. Forcing a 
child's mental processes in any way is harm- 
ful; it may be done in attempts to make the 
child talk or express himself in other w^ays, 
by too long or too early stories, too early 
study, etc. A child's animal existence 
shoiild be made the chief concern for as 
many years as need be to establish perfect 
health. The mental development will usu- 
ally take care of itself, and even if a trifle 
late may be only the more vigorous therefor. 

171 



The Nursing of Children 

Probably one of the most important prin- 
ciples in the treatment of nervous children 
is that they should not, under any circum- 
stances, hear a hint of the fact that they are 
nervous. It takes a surprisingly short time 
for a child to learn to demand sympathy for 
trifling ailments or for "nerves," and the 
results are most disastrous. Even real ill- 
ness should be made as little of as is consist- 
ent with proper care. 

The nurse who does not honestly love chil- 
dren and to a degree understand them, 
should not imdertake the care or nursing of a 
nervous child. She must be able to enter 
into his plays, to exercise great patience and 
gentleness. High-strung children respond 
beautifully to real sympathy and love, and 
develop charm and sweetness of character 
under the right treatment. Suggestion, al- 
ways positive in character, can be used to 
great advantage. 

For a child who has uncontrollable fits of 
temper there is little to be done at the time, 
except to keep him from injuring brother, 
sister or playmate, restraining him forcibly 
if necessary. When the paroxysm of anger 
is over, and he is ready to sit in your lap 

172 



The Nursing of Children 

(you must not be too starchy and immacu- 
late to be in\dtmg), have a little heart-to- 
heart talk, telling him gently how ugly the 
whole thing is. Try to arouse in him a wish 
to get the better of these spells. If the little 
talks do not help as much as could be de- 
sired, try letting him alone after he has been 
naughty. Do not play wdth or talk to him. 
The average child will feel this treatment 
keenly, understand it and in a short time 
say he is sorry. 

There are many stories which may be read 
to a child to help to create in him a desire to 
rule himself. The ^'Little Colonel'' series 
is excellent. ^^ The Twins and Why,'' by 
Thompson, is also good. The Ubrarian of 
your pubUc hbrary will suggest others. 
Much patience and some wisdom must be 
exercised by the nurse if she is really to help 
a nervous child to recover. 

Diet is of paramoimt importance in the 
care of nerv^ous children. The doctor's 
orders are to be followed carefully, to be 
sure, but often those orders are simply, 
"Feed him carefully." Children whose 
nutrition is not good sometimes need as 
many as five meals a day. They must be 

173 



The Nursing of Children 

simple and should be served at regular 
hours. The diet which gives energy and 
endurance is chiefly meat, eggs and milk. 
Upon these articles as a foundation many 
variations may be built up. A good cook 
book and a little ingenuity will do much. 
There are all sorts of egg and milk dishes to 
be made, and even such simple things as 
milk toast, bread and milk, egg-nog, oyster 
soup, etc., are frequently acceptable. Chil- 
dren do not demand the variety which 
grown persons do. Green vegetables are 
always allowable and help out a great deal; 
they give variety and are in themselves 
wholesome and desirable. 

Daily Routine is of special value in ner- 
vous cases. Meals at regular hours, a 
special time for a nap, a certain number of 
hours out-of-doors, and an exact bedtime are 
really easier as well as better than haphazard 
planning. 

The daily cool sponge bath should be 
given in the morning before breakfast. If 
the child chills or complains of the cold 
water, it may be made tepid, care being 
taken that the invigorating effect is not lost. 
If the child objects to baths, find out what 

174 



The Nursing or Children 

the reason is and take steps to overcome it. 
Toy boats to be sailed while the bath goes 
on, stories of naval battles with the toys for 
illustrations for boys, or tales of ocean trips 
for the girls, or any play which can be con- 
nected with the bath, will make the child 
help to forget that he is doing a duty, and it 
may become a pleasure. 

Out-of-doors must be made interesting, so 
that the child vnR want to be out pretty con- 
stantly. A Httle garden can be made a 
source of the purest pleasure; it matters very 
Httle whether flowers or vegetables be 
gro^Ti. Flowers may be examined and their 
names learned. Trees may be studied. 
Most children, except very tiny ones, find 
great interest in the habits of birds. A 
gentle horse is a godsend. A tent to play 
house in, a s^dng for repeated short pastime, 
or other simple and not too strenuous appar- 
atus should be provided. The right sort of 
playmates are the best of all. If the nurse 
is not familiar with out-of-door Kfe, this will 
be an excellent time for her to gain some 
valuable information. There are so many 
books to be had w^hich help one to know 
about outdoor things, and some one can 

175 



The Nursing or Children 

always be found, by searching, who knows 
Nature's ways. The education afforded by 
these things is worth something, the health 
gained more. 

Modern modes of living tend to muscular 
degeneration, both in young and old. The 
city child has not a chance for proper play, 
and tends always to flabby muscle, flat chest 
and general poor development; this physical 
condition relaxes the will power, and tends 
to nervousness and lack of self-control. 
Frequently the solution of the difl&culty lies 
in a good gymnasium and a skilled trainer. 
The desire to keep up to the class standard 
in physique, the wish to do a certain "stunt," 
the delight of contest in a game, or the joy 
of team play, should all be considered, and 
the child given his chance at them. A 
proper course in physical training, bringing 
the boy or girl to proper symmetry of 
body, a quickened brain and a stimu- 
lated will power, invariably means resis- 
tance to disease and the decrease of 
nervousness. 

Nervous conditions manifest themselves 
in many very definite ways, and each must 
be dealt with in a particular fashion. 

176 



The Nursing of Children 

Nightmare is persistent in some children. 
It may take the form of a vague dream of 
some evil influence which pursues, or may be 
something more defined, the child waking in 
terror and being hard to reassure of the 
imreality of his experience. Diligent search 
should be made for the underl3dng cause of 
this trouble. It may be due to disturbed 
digestion from heavy food, to malnutrition, 
to adenoids, to enlarged tonsils, or may even 
be an accompaniment of epilepsy. These 
cases tend to recover, but everything should 
be done to hasten the work. 

Hysteria is not unconoimon in children, 
and is not to be neglected. Mobius defines 
it as ^' a state in which ideas control the body 
and produce morbid changes in its func- 
tions." In children it may be due to bad 
inheritance, faulty education, mental shock, 
or an injury of some sort. It may be due to 
attempting to frighten a child into obedi- 
ence, and he may never be able to entirely 
overcome some manifestation of it. 

Treatment is mainly mental, with special 
attention given to the correction of any 
accompanying physical ills. A change of 
environment and contact with a new set of 

177 



The Nursing of Children 

people often does wonders. For serious 
cases, it may be necessary to consult a nerve 
specialist. 

Chorea, or St. Vitus' dance, is a condition 
characterized by local or general involuntary 
and irregular twitching of the muscles or by 
incoordinate movements. It may follow 
any period of depressed vitality, may be due 
to heredity, to fright, worry, an injury, 
excitement, etc. It occurs most commonly 
between the ages of six and sixteen. The 
attacks may vary all the way from those 
which involve one limb to those in which the 
face, all the limbs and practically the whole 
body is affected. These patients are very 
sensitive and the movements become more 
pronounced when they are observed. Vol- 
untary movements are imcertain and jerky, 
and the patient may be unable to hold things 
securely in his hand. The speech may be 
afifected. Lack of concentration and irrita- 
bility of temper are characteristic. The more 
severe the case the greater will be the mental 
disturbance. In some instances the move- 
ments continue during sleep. In extreme 
cases, the pulse may be weak and rapid, 
and there may be some danger of paralysis. 

178 



The Nursing of Children 

These cases may last a few weeks or a few 
months. They tend always to recover. 
Real consideration, proper and happy envir- 
onment are the most important factors in the 
treatment. Nutritious food, moderate ex- 
ercise and an outdoor life are necessary. As 
little notice as possible should be taken of 
the nervous manifestations. 

Convulsions in yoimg children may or 
may not indicate a serious condition. They 
are not uncommon, and may be mild or 
severe. In the mild cases there is rigidity 
and spasm of the hand or face, rolling of the 
eyes, and it is over. In the severer cases, 
there are marked convulsive movements, 
twitchings or jerkings, blueness of the lips, 
impaired respiration, rapid pulse and uncon- 
sciousness. Frothing at the mouth may 
occur. After several minutes the twitchings 
may cease and the child remain imconscious. 
The convulsion may recur after several 
hours. 

One should endeavor, if possible, to ascer- 
tain from a physician the cause of convul- 
sions in any given case, and institute treat- 
ment for its removal. The condition may 
be due to heredity, or it may follow a shock 

179 



The Nursing of Children 

or almost any illness. In quite young chil- 
dren it may be assigned to teething, which 
usually means digestive disturbance. 

Treatment must be inmiediate. A hot 
mustard bath can be quickly prepared, the 
temperature being only what may be borne 
by the back of the hand, and the child placed 
in it without even troubling to remove 
clothing. The warmth usually relaxes the 
spasm. A spoon handle, wrapped in a clean 
handkerchief, or a soft towel folded several 
times, may be slipped between the child's 
teeth to prevent him biting his tongue. If a 
hot tub bath is not practical, a hot pack may 
be given with equally good results. A doc- 
tor should in most cases be sent for if the 
attack is severe or continues more than a 
few minutes. He will direct in regard to 
any sedatives which may be given. Chloro- 
form may be given for the attack under his 
direction, but great care should, of course, be 
exercised. 

After the attack, it is wise to give a dose of 
castor oil, and a thorough enema of salt 
solution. Special attention should be paid 
to the diet. The child should be kept quiet 
for some time. 

i8o 



The Nursing of Children 

Epilepsy is a nervous disorder which usu- 
ally develops in childhood. The attacks 
may resemble convulsions; they are usually 
preceded by a peculiar sensation which is 
termed an aura, and are commonly accom- 
panied by a characteristic cry. 

Epilepsy in children is almost invariably 
the result of a bad heredity. It may be due 
to nervous disease in the parents, to tuber- 
culosis, to syphilis, alcohoUsm, etc. Any 
shock or excitement may bring on an attack, 
but sometimes there appears to be no imme- 
diate cause. There is no bright outlook for 
these cases, as they tend to grow worse. As 
the disease progresses the mind weakens. 
If there are no attacks for two years, some 
hope of cure may be held out. 

The care consists in keeping up the nutri- 
tion and improving the general health. All 
causes of irritation to the nervous system 
should be removed. Outdoor life is to be 
preferred, and some light and pleasant em- 
ployment. These children frequently do 
well in an institution especially designed for 
their care. They cannot be expected to get 
on in the ordinary school. 

During the actual attack, there is little to 

i8i 



The Nursing of Children 

do except to see that the patient does not 
injure himself by falling or in any other way. 
He should be placed in bed if convenient, or 
in a comfortable place until he recovers. 

No cure has been found for epilepsy. Ex- 
periments are being made with a serum pre- 
pared from rattlesnake poison, and it has 
seemed to be successful in some cases. 

A certain number of cases of epilepsy are 
due to injuries of the head, usually to a 
fracture of the skull which causes pressure 
on the brain. These cases are usually cured 
by operation. 

Feeble-minded children are being studied 
very carefully of late. They are a pitiful 
illustration of the sins and weaknesses of the 
parents being visited upon the children. 
Some cases are apparently due to injuries to 
the pregnant mother or to some diseased 
condition during pregnancy. The condition 
is frequently laid to marriage with one near 
of kin, but the explanation of this probably 
lies in the doubling or accentuating of a 
similar weakness or mental trait in both 
parents. 

Three classes of the feeble-minded are now 
recognized — ^idiots, imbeciles and morons. 

182 



The NimsiNG of Children 

Idiots are those whose mental develop- 
ment does not go farther than that of a 
child a few years old; they require constant 
physical care and cannot be taught to do 
anything of consequence. They are most 
appropriately cared for in institutions de- 
voted to such cases, as they are alw^ays a 
burden to their famihes. Their outlook is 
very discouraging. 

Imbeciles are those whose mental devel- 
opment attains to that of a child seven or 
eight years old, but never goes much beyond 
that. They respond to teaching, but it 
must be carefully done, and by one who is 
familiar with such cases, if good results are 
to be had. These persons may be taught to 
be partially or wholly self-sustaining if in- 
structed in simple manual labor, and may 
even learn the rudiments of school educa- 
tion. They may do well in music and in 
some of the arts. 

The early Ufe of such children is best spent 
in an institution where they may be prop- 
erly taught and where they are not discour- 
aged by constant contrast with normal chil- 
dren. Later they may take their place in 
the home, if their families and friends are at 

183 



The Nursing of Children 

the same time taught not to expect too much 
of them. They should not be allowed to marry. 

Morons are high-grade defectives, who 
are often diflScult to distinguish from normal 
persons. In this class come the so-called 
^* backward" children and persons who lack 
in judgment, in ability to get on, etc. They 
need special care and attention, but are not 
apt to get it unless their deficiency is recog- 
nized. Some test should be applied in order 
to discover the degree of deficiency. The 
Binet tests are the best known and are 
interesting for a nurse to inform herself about. 

But a few years ago all mental defectives 
were considered discouraging cases. Now, 
their care and training has been given more 
attention, and wonderful results have been 
obtained in the education of those thought 
to be hopeless. A nurse who meets with a 
child who is plainly feeble-minded or whom 
she suspects of a mental deficiency, should 
do all that she can to have the child taken 
to a specialist for examination. If the de- 
fect is at all marked, she should urge that 
the child be sent to an institution where he 
may have the training needed for his devel- 
opment. 

184 



PART XII 

Clothing 

CLOTHING may make or mar a child's 
comfort quite as much as it does a 
grown person's. Scientists have recognized 
the fact that a man does not do his best work 
unless he is properly and comfortably 
clothed, and that discomfort in clothing, 
even if unrecognized by the wearer, may 
produce nerve strain and cause a very defi- 
nite waste of vital force. 

There are principles underlying proper 
clothing of children quite as important and 
quite as definite as those governing their 
feeding. One needs, also, a certain amount 
of common sense exercised in the matter 
and enough imagination to reaUze how one 
might feel oneself under similar circum- 
stances. Children are like grown people in 
some respects, in others radically different, 
and this must be taken account of in clothing 
them. 

Children are very active when awake and 
very quiet when asleep. Their circulation 
is usually good and their skin action vigor- 

185 



The Nursing of Children 

ous. They therefore perspire easily and 
chill readily. For this reason, the exact 
amount of clothing which they have on is 
more important than it is for a grown per- 
son. Too much or too little are more serious 
matters than with adults. Their heat radia- 
tion is rapid, but they become overheated 
somewhat more readily than adults do. 

The first and most important principle is 
to clothe all portions of the body evenly. No 
doubt most of the errors in clothing are due 
to neglect of this principle. It is very com- 
mon to see children clothed so heavily in 
one part of the body as to cause almost con- 
stant perspiration and consequent chilling, 
while another part is left exposed. Some of 
the ideas about '' hardening" children have 
rather disastrous results. Imagine yourself 
dressed after the fashion of the average 
child, your chest and arms loaded with 
wraps hot and cumbersome, while your legs 
were exposed nearly to the knee or clad in 
but one thickness or, rather, thinness of 
material. With little girls, the cold air 
usually has access halfway up the thigh. 

The chest and abdomen, since they con- 
tain the vital organs, should doubtless be the 

i86 



The Nursing of Children 

best protected parts of the body, but one 
additional thickness is all that is needed for 
them. This is usually supplied by the shirt. 
Outside that, clothe the entire body evenly 
with as many layers as the temperature 
demands. The entire body should mean up 
to the neck and to below the elbows and 
knees in warm weather; in cold weather, a 
few inches further in each locality. 

At the Massachusetts General Hospital, 
in the children's department of the out- 
patient clinic, there is hung a sign for the 
mothers: ''Dress your baby according to the 
weather, not according to the season." It 
. is well, also, to remember that in city Hfe and 
in school the room temperature is that of 
summer heat. Children in steam-heated, 
closed-up rooms should, therefore, be clothed 
rather thinly, but should be supplied with 
abundant long wraps when they go out into 
the cold. Country houses, the homes of the 
poor, or outdoor schools, are quite another 
matter. Some allowance should also be 
made for the fact that children will run out- 
of-doors without stopping for wraps; but in 
this connection one may save themselves 
some worry if one remembers that children 

187 



The Nursing of Children 

are apt to indulge in violent exercise when 
out-of-doors, and suffer much less than an 
adult would under similar circumstances. 

There is considerable discussion among 
the authorities as to what material is most 
suitable for the underwear of small children. 
The advocates of wool seem to be in the 
minority, for while wool is a non-conductor, 
it does not absorb perspiration well, and is 
irritating and uncomfortable to a sensitive 
skin. It is unobjectionable if the person 
wearing it finds it comfortable, but has no 
special advantages. Cotton is a good con- 
ductor of heat and cold, absorbs perspira- 
tion, but allows the body to cool rapidly. 
Linen cloth is even more objectionable than 
cotton. Linen mesh is, however, a non- 
conductor, absorbent and unirritating, and 
seems to be ideal for both summer and 
winter. Silk has similar properties, but is 
expensive. 

Remember that an air space in clothing, 
as well as in buildings or refrigerators, stops 
the passage of either heat or cold. For this 
reason, several layers of thin garments are 
warmer than a few layers of thick ones. In 
summer, however, the cooling action of the 

i88 



The Nursing of Children 

perspiration must be taken into account and 
clothing furnished which will afford free cir- 
culation of air to the body. 

The baby's first wardrobe has already 
been discussed. A small baby, living at a 
summer temperature most of the time, is 
likely to be too warmly clad. When taken 
out, very few persons remember to protect 
a baby's neck from drafts. They also forget 
that the eyes should be shaded from bright 
light; if a bonnet is worn, a parasol or cover 
to the baby cab must be provided. An 
older child may have a cap with a visor. 
Bear in mind that a yoimg baby lies down 
and is therefore more exposed to direct light 
than one who is old enough to sit up. Neg- 
lect to shade a baby's eyes from glare of 
light is said to be responsible for some eye 
troubles. 

The first shoes should be soft, preferably 
of chamois or some of the leathers which can 
be bought by the piece and m.ade up at 
home. When the child begins to walk, a 
stiff-soled shoe should be provided, but it 
should be large and loose. Orthopedists 
do not agree with the popular notion that 
loose shoes are injurious. It is also becom- 

189 



The Nursing of Children 

ing less common to insist upon shoes which 
^^ support the ankle," the modern idea being 
to give the ankle free play and make it 
strong, so that it will not need support. All 
orthopedists agree that high heels are bad, 
and that heels of any height are unneces- 
sary, to say the least. Going barefoot is 
not advisable, as serious infection may be 
gotten in this way. Sandals protect the 
feet from injury pretty well and are usually 
comfortable for the child. There is, of 
course, no objection to letting a child go 
without shoes or stockings indoors, where 
there are smooth floors and soft rugs. 

To be explicit — a young baby may wear 
indoors in hot weather only a light band and 
a thin napkin. In cool weather a shirt, a 
petticoat which covers the legs, and a slip. 
Out-of-doors, a long coat which comes close 
around the neck or, better, one which 
has a hood attached. The eyes should be 
shaded. 

Little children who wear short clothes 
should wear closed bloomers reaching 
below the knee, and under-drawers to the 
ankle in cool weather. Coats should be as 
long as the child can get about in. In hot 

190 



The Nursing of Children 

weather a shirt, drawers and a dress are 
sufficient. In very cold weather, the neck 
and ears may need protection when the 
child goes out. Little girls are more com- 
fortable and more modest in knickerbockers 
than in petticoats, and most children prefer 
them. They may be used until the girl 
puts on long dresses. 

The simplest and easiest rule for modify- 
ing a child's clothing to suit climate or 
weather is: If less is needed, remove a whole 
layer; if more, add a whole layer. 



191 



PART XIII 

Teaching 

^TpHE nurse who has the care of children 
A will find that a knowledge of teaching 
methods is not only advisable, but almost 
a necessity for her. Mere amusement for 
the sake of amusement soon bores the child, 
as well as the one who is attempting it, while 
things with a real value and a permanent 
interest are more eagerly received and sat- 
isfy for a longer period. The real things 
mean the acquiring of knowledge or of in- 
formation, or the development of mental 
quaUties. These things are all in the 
teacher's field. 

It is becoming a not unusual thing for the 
tired mother or the parent who wishes a 
vacation not suitable for children to leave 
the children in the care of a trained nurse. 
For many reasons, nurses have been found 
more satisfactory than governesses, and a 
certain number of nurses every year find 
themselves with a well child on their hands. 

Even in the ordinary case of illness, there 
is the discipline to be studied. In convales- 

192 



The Nursing of Children 

cence, much real teaching may be done. 
There is a very definite place in the world 
for the nurse with teaching knowledge, and 
the young woman who can furnish this sort 
of service mil find herself in demand. 

It is out of the question for the nurse to 
take a kindergarten course or a normal 
school course. She may, however, spend 
some of her spare time, even while on a case, 
in reading books on teaching methods and 
on discipline, and in this way get hold of 
some of the fundamental principles which 
will be of great value to her. The following 
books \\dll be foimd useful in furnishing sug- 
gestions for methods with the yoimger 
children : 

^^In the Child's World.'' Poulsson. 

'^Kindergarten Principles and Practice." 
Wiggin & Smith. 

'^Froebel's Occupations." Wiggin & 
Smith. 

"The Home-made Kindergarten." Nora 
A. Smith. 

There have been many interesting articles 
in recent magazines concerning the Montes- 
sori method of teaching, and it is now being 
extensively introduced into this coimtry. 

193 



The Nursing or Children 

A half day's reading will serve to make the 
nurse familiar with the principles of this 
method, and her knowledge of it will make 
her of a good deal of value to many a busy 
mother. A visit to one of the Montessori 
schools which are being established in the 
larger cities is also well worth while. 

Dr. Montessori is an ItaUan whose origi- 
nal research was done for the sake of feeble- 
minded children. She presently found that 
the same methods were successful with 
normal children in their early years. 

Dr. Montessori believes in the importance 
of training the special senses, especially the 
tactile sense. She excludes as far as possi- 
ble all senses but the one in hand at the 
time. For example, in teaching a child to 
note the sounds which most of us pass un- 
heard, she blindfolds him or has several 
children together in a dark room, so that 
they shall not be distracted by other things. 
In her tests for touch sensations and in its 
teaching, she directs the bUndfolded child to 
touch lightly the material given him, learn- 
ing all that he can about it in this way. She 
teaches writing and drawing by having the 
children feel the forms; when they have 

194 



The Nursing of Children 

learned them by the sense of touch it is but a 
step to transfer them to paper or blackboard 
by the same series of movements. When 
we consider how necessary a highly devel- 
oped touch is in the finer things of life, the 
musician's touch, the surgeon's touch, the 
sculptor's, the painter's, even the work of 
embroidery, sewing, and many of the domes- 
tic arts, we see that her ideas are funda- 
mental. 

She apphes her work and the children's 
knowledge to their ever>"-day life. She 
would teach them to attend to their own 
needs. Some of the lessons are given with a 
view to enabling a child to dress himself and 
to assist the other children. By her meth- 
ods the child learns to read and to write 
almost imconsciously, and lays the foimda- 
tion for all his future work. He learns con- 
centration of attention without fatigue. He 
learns to coordinate his muscular move- 
ments, w^hich is the foimdation of all physi- 
cal grace and health and of all manual dex- 
terity. He acquires very readily a general 
stability which ordinary teaching methods 
do not give. 

The Montessori system advocates special 

195 



The Nursing of Children 

gymnastics to develop the normal body and 
to correct any existing defects. A proper 
swing in which the child propels himself, a 
rubber ball suspended from the ceiling and 
used for games, a rope ladder, etc., are 
among the apparatus used. Outdoor games 
like the hoop, bean bag, ball, and hide-and- 
seek are advocated. Breathing exercises 
and teaching in correct enunciation are also 
a part of the method. 

It is quite worth the while of any nurse 
who deals with children to read one or 
more books on the Montessori method, as 
there is much in it which is thoroughly 
practical. 

The nurse with a convalescent or well 
child on her hands may find joy to herself, 
the child and its parents, if she takes the 
opportunity to teach a manual occupation. 
Children love to make things, and an illness 
will be remembered with pleasure if the 
child has been able to learn basketry, weav- 
ing of any sort, crocheting, wood carving, 
pyrography, embroidery, lettering, or any of 
the many useful and decorative arts which 
require a small amount of apparatus or 
material. There is hardly a nurse who does 

196 



The Nursing of Children 

not know a few of these arts, and hardly a 
child who would not be delighted to learn 
one of them. When time hangs heavy, the 
opportunity is there. 

One may even teach songs or short poems, 
or have the child and herself take part in a 
simple dialogue. All these activities are 
instructive as well as entertaining, and the 
parents will appreciate them as much as the 
children do. 



197 



PART XIV 

Entertaining Children 

A LITTLE girl, who on previous occa- 
^ ^ sions had been under the care of two 
different nurses, was asked by her mother 
which of the two she preferred. She replied, 
'^They are both nice, but I think I'd rather 
have Miss M., because she plays the 
most.'' 

The average nurse needs to have in mind a 
list of things which may be done to entertain 
a child or which he may use to entertain him- 
self. There is hardly a case where some 
sort of amusement or occupation is not 
demanded. In some instances the child's 
mind should not be stimulated, and a simple 
manual occupation is appropriate. In other 
cases, such as typhoid or some forms of heart 
trouble, it is unwise for the child to use his 
arms, but he will enjoy directing the nurse 
or joining in her planning, or exercising his 
mind to a mild degree. 

Hearing stories is the one never-failing 
source of amusement to a child. They may 
be read, if one puts a proper spirit into them, 

198 



The Nursing of Children 

but greater still is the joy if they can be told. 
There is also a distinct pedagogical value in 
the child's repeating stories which he has 
heard, and the nurse should encourage him 
to do it. The average child is delighted to 
have an appreciative audience, and he will 
be charmed to retail to parents or other 
members of the family a stor\' which his 
nurse has told him. Even poems which 
seem a Httle beyond a child's inteUigence are 
often of great interest to them. A four- 
year-old has been heard to Hsp with the 
greatest pleasure part of ^^ Blessings on thee, 
little man." An eight-year-old found joy in 
Lamb's ^^ Tales from Shakespeare." Chil- 
dren are frequently as appreciative of good 
literature as are grown persons. 

Bible stories invariably appeal to children, 
but one should be careful before beginning 
them to find out the parents' views in this 
matter. Some people prefer to wait for 
these stories until more mature years, but 
there are certain of the simpler tales from the 
Bible which any child can understand. With 
what breathless interest do they Hsten to 
David and GoHath, or Daniel and the lions, 
or Moses in the bulrushes, invariably wish- 

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The NimsiNG or Children 

ing to hear them again or to repeat them 
themselves. 

In these days of public libraries it should 
not be difl&cult for the nurse to obtain mate- 
rial to read or tell to a child. The librarian 
will invariably help one in these matters. 

Remember that children love to hear their 
favorites over and over, long after grown 
persons are tired of them. If a story is to be 
told, the nurse should try to find in it the 
good, worth-while points and bring them 
out. For example, in "The Three Bears'' 
and ^^ Little Red Riding Hood," there is the 
thought of a good influence ever watching 
over the child and protecting him. In this 
connection, some of the old-time stories need 
a little reconstruction, and some, such as 
"Bluebeard,'' should be eliminated. 

There are stories and poems which lose 
much by being told, and should be read in 
order to keep the very words of the author. 
By dwelling on certain parts of them the 
nurse can positively create a love for good 
literature, and by so doing will have laid the 
foundation for many happy and profitable 
hours in the child's life. 

Making an old-fashioned scrap-book is 

200 



The Nursing of Children 

ever interesting. If the child is not able to 
do it himself, he may enjoy directing the 
work, choosing the pictures and deciding 
where and how they shall be placed. Al- 
most every home has old magazines contain- 
ing a wealth of pictures which the child may 
cut out for this purpose. 

Paper cutting of all sorts has great possi- 
bilities. For details, refer to some kinder- 
garten work. 

Fashion plates may be colored by pencils, 
crayons or water-color paints, whichever the 
child has or can best manage. Two-hole 
bone buttons fastened on figures in place of 
heads make very amusing combinations. 

Picture post-cards, or larger pictures with 
a backing of cardboard, may be cut up into 
picture puzzles, and will while away many 
an hour. 

Stringing beads is easy and interesting. 
The Hailman kindergarten beads of wood, 
made in cubes, cylinders, spheres, etc., are 
easy to handle and give training in color and 
form. Smaller beads may be used to make 
a neck string for a doll, or for mother or sister. 

Large beads combined with toothpicks 
make excellent soldiers. In fact, tooth- 

20I 



The Nursing of Children 

picks are most useful by themselves and in 
combination with such things as raisins, figs, 
cherries or any small fruit. 

Corn-cobs and corn-husks, burdock burrs, 
pine-needles, and most of the flat leaves can 
be made into all sorts of things. 

Modeling clay all ready to mix can be 
purchased; with his fingers and one or two 
simple tools the child can spend many 
happy hours modeling familiar objects. 

For older children the making of blue- 
prints from photographic plates or films is a 
fascinating occupation. 

For the little girl of almost any age a doll 
is the great source of entertainment. There 
is no end to the plays which may be planned 
with a doll and a liberal amount of imagina- 
tion. If she is able, any amount of sewing 
may be done — dresses, underwear, play 
clothes, aprons, hat, stockings and shoes, 
etc., can all be made with a little help from 
the nurse in planning and execution. An 
old scrap-bag is a veritable treasure-house. 
A trip may be planned and taken, using a 
cigar box divided into compartments for a 
trunk, if no better is available. Giving a 

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The Nursing of Children 




HAPPY WITH HOME-MADE TOYS 



doll party is always great fun and takes end- 
less planning. 

For a change, try making hickory nut 
dolls, with the face painted or drawn in pen 
and ink, the body being made of a little roll 
of cotton cloth glued to the nut. The face 
may be grotesque and the clothing comical. 
The arms are made of small rolls of cloth 
sewed to the body. A corn-cob, dressed in 
corn-husks, makes a very funny clown doll. 

Paper dolls are always in order, and may 
be managed with less exertion to the child. 
Even a pretty sick child may handle them 

203 



The Nursing of Children 

with ease and get a great deal of pleasure 
from them. 

A boy will usually be interested in some 
sort of constructive work. He may build a 
house of pasteboard, using four boxes glued 
together or sewed. It should not be too 
simple, nor too small. There may be up- 
stairs and down-stairs, with the stairway 
made of folded pasteboard. A lean-to 
kitchen can be fastened on and a porch added 
in front. The exterior color can be decided 
by the little patient, and executed in colored 
paper, crayon or paint, whichever is avail- 
able. The interior may be decorated and 
furnished. Doors and windows are cut out 
with a sharp knife. Curtains may be made 
of crepe paper or cloth. Pictures can be 
hung and rugs put down. Small boxes will 
do for furniture, or pasteboard cut, bent and 
sewed or tacked. 

Sometimes a small boy may be interested 
in dressing up a teddy bear with simple 
clothing for which the nurse may cut a pat- 
tern and do any necessary sewing. 

Either boys or girls like to make things for 
other people, especially if some holiday or 
anniversary is near. For May Day there 

204 



The Nursing of Children 

are May baskets of all sorts of sizes and 
materials. For Valentine's Day a supply of 
colored cardboard, tissue paper, lace from 
soap or candy boxes, and colored pictures 
cut from old magazines will furnish the basis 
for valentines for all the friends of the family. 
If the child is old enough, the nurse may help 
him compose simple rhymes for the valen- 
tines. 

Near Easter time eggs and egg-shells may 
be colored in all sorts of ways. Faces may 
be drawn on the shells and a bonnet of crepe 
paper made, with ribbon or paper for 
strings. Half an egg-shell can be decorated 
and used as a vase, being sent to a friend 
with a flower or a few wild violets in it. 

For Christmas gifts there are endless sim- 
ple things which can be made. Bright tissue 
papers cut with a fancy edge and mounted 
on a pasteboard back for shaving paper for 
the child's father; a holder for the mother, 
or a towel to be hemmed or hemstitched; a 
simple Uttle apron for a sister; a pen- wiper 
made of several pieces of flannel, scalloped, 
for the brother — and so on. It may fall to 
the nurse to do most of the actual work on 
some of these things, but the happiness of 

205 



The Nursing of Children 

the child in watching or directing the work 
will be worth while. 

Children between three and six years 
enjoy putting things together. There are 
cubes in graduated sizes, which may be put 
inside each other, or piled up in many ways. 
There are cylinders in sets of ten sizes, made 
to fit into holes of the same size. These 
things give training in judging of the relative 
sizes of objects, and the child spends his 
time with them profitably. 

The nurse must take care that she does 
not permit the child to overdo and so defeat 
the very object for which she is striving, the 
improvement of the child's physical health. 
A child in health cannot keep his mind and 
attention upon one thing very long at one 
time, and the child who is ill tires even more 
quickly. The amusements and occupations 
should therefore be as varied as may be, and 
there should be periods of as complete repose 
as the child's disposition will permit. 

If there are other children in the family 
who are admitted to the sick-room, or if 
visitors are allowed, all sorts of games may 
be undertaken. A book of games may be 
gotten from the public library and some new 

206 



The Nursing of Children 

ones learned. ("Gaines and Songs of 

American Children," by William Wells 

Newell is a good one.) There are many 

guessing games, both simple and intricate, 

which may be used according to the age and 

mental development of the child. There is 

the well-known "Bachelor's Kitchen" and 

other similar games. There is one called " My 

Household," which may be played by few or 

many, the child beginning with the verse 

I had a little (lamb) and my (lamb) pleased me 
I fed my little (lamb) beneath that tree, 
My little (lamb) went (M-a-a) . 
Other folks feed their (lamb) , I feed my (lamb) 
too. 

For each verse the children choose a 
different animal and in the third line imitate 
its cry. It becomes a noisy game, as the 
chorus consists of all the animals together. 

If the child may go out-of-doors, there is 
much of interest to be found. The child 
may be blindfolded and all sorts of things 
brought to him to be guessed by smeUing or 
feeling of them. If the ground is not too 
damp, the child may be Hfted to a cushion 
placed by a sand-pile and can make all sorts 
of things there, houses, rivers, lakes, villages, 
gardens, etc. 

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The Nursing of Children 

It is not dfficult to arrange a sand-box for 
indoors. A shallow wooden box small enough 
to be propped on the bed, with a small 
amount of moist sand in it, will be a source 
of great pleasure to almost any child. 

A little ingenuity, a few books from the 
library, and a real interest and love for chil- 
dren will make the nurse's task of entertain- 
ment an easy one. 



208 



